Gibbons and colleagues take a similar approach to that of Simon and Savarino by examining the rate of suicide attempts before and after the initiation of treatment in the Veterans Administration (VA) health care system. In contrast to the study by Simon and Savarino, Gibbons and colleagues have a comparison group with a diagnosis of depression that did not receive antidepressant treatment, although it could not be determined with the extant database whether the patients in any of the groups received psychotherapy. All of the treatment groups, regardless of the type of antidepressant prescribed, showed large decreases in the rates of suicide attempts after initiation of treatment. In addition, Gibbons and colleagues also showed that the rates of suicide attempts in patients treated with an antidepressant were roughly one-third of those observed for patients who were not treated with an antidepressant. It is possible that, as posited by Simon and Savarino, these findings are at least in part due to a high rate of referral for treatment of depression shortly after a suicide attempt. However, the decline in risk for suicide attempt in the treated compared to the untreated group makes a stronger case that such changes are due to the protective effects of treatment per se. Another possible explanation for the higher rate of suicidal behavior in the untreated group is that lack of treatment may be due to lack of adherence and concomitant psychosocial factors (e.g., personality disorder, alcohol abuse) that may increase suicidal risk. Although the FDA's analyses of randomized trials found an elevated rate of suicide attempts in young adults ages 18—24 treated with drug versus placebo, in this study, within the same age stratum, the risk of suicide attempt in the treated group was one-third that of the untreated group (4). It is possible that the divergence between the FDA's analysis and the report by Gibbon et al. is accounted for by a difference in the baseline characteristics of the two samples: patients at high risk for suicidal behavior are excluded from clinical trials, whereas such patients were highly represented in this VA-based observational study.