Family conflict, drug or alcohol use, and preexisting suicidal thoughts were associated with the occurrence of suicidal events among depressed adolescents who switched treatments after lack of response to a selective serotonin reuptake inhibitor (SSRI). Brent et al. (p. 418) report that the 334 patients were treated with a different SSRI or venlafaxine, with or without cognitive-behavioral therapy (CBT). Overall, the treatments did not differ in the frequency of suicidal events, which occurred a median of 3 weeks from treatment onset. However, among patients with high baseline levels of suicidal thoughts, those taking venlafaxine were more likely to have self-harm events. Benzodiazepine prescription was also associated with increased suicidal events. CBT did not have a protective effect on suicidality. During the trial, assessment of self-harm was changed from spontaneous patient reports to systematic monitoring, which revealed a higher number of overall suicidal events but a similar number of serious adverse events. Dr. Myrna Weissman discusses these findings in an editorial on p. 385.