Now, if you want to turn that around and say that’s still not enough, that 2 excess children having suicidal ideas is too many, then sure, price in some reasonable precautions. The odds against a 20 sigma study would be so great as to require the inadequacy of the study on other grounds (systematic error).

But no, at some point you have to say: These 3999 positively (!) reacting teens are good evidence for me, and the 1 other could very well be the product of some other unfortunate circumstance. This isn’t even in the realm of this Commentary, though. The value is within 1sigma of 1 here, so there isn’t sufficient evidence to draw any hard conclusion. He also explicitly says that the black box warning is not about discouraging use, but warning about the danger of not monitoring; the reality is unknown, doctors are encouraged to be perceptive.

You say: “The data do not “fail to rule out” suicide risk (no possible data could “rule out” such risk, i.e., show the risk is zero); they manage to overcome a barrier to show it’s there.

This is certainly not true. I have been willing to give you the benefit of the doubt on many things, as this is not my field, but one thing I have learned is an appreciation for the depth of people such as Leon. I may not understand the analyses he walks us through, but I do know that such processes are created for a reason. I am amazed that you feel capable of dismissing them without any reasoning yourself. You must think he has not gone far enough in restricting these drugs, but the evidence you seek does not seem to be in this report.

Lasser: it’s not hard to imagine that some people have inappropriate levels of the basic neurotransmitters in the brain, a natural “chemical imbalance”. In that case it seems perfectly reasonable to me to plan on replacing those chemicals with a pill, as opposed to suggesting they exercise or eat more ice cream. To insist otherwise, as say the Scientologists might, is to turn one’s back on centuries of confidence building in science. I know you’re not taking this stance, but I think much of the public is still attached to the stigma against anti-depressants.

But the question on if anti-depressants are necessary and if they are, in fact, better than other less abrasive treatment methods is still questionable to me.

Messing around with one’s brain chemistry does strike me as potentially dangerous. It might subdue the depression, but the side effects are unknown.

If more organic means can provide the same benefits as the abrasive means, then it’s an easy decision. Yet psychiatrist don’t seem to be open to the organic means.