Objective: To describe the temporal prescribing patterns of selective serotonin reuptake inhibitors (SSRI) and similar antidepressant medications among pediatric patients covered through a state child health insurance and Medicaid program from 2000 through 2007. Methods: Administrative claims data from the health insurance programs of the Arkansas Department of Human Services were examined from July 2000 through June 2007. Continuously eligible patients under age 18 were identified in 14 6-month time periods. Pharmacy claims data identified all covered recipients receiving a prescription for any antidepressant obtained from an outpatient pharmacy. Considering published data on use in children, antidepressant medications were characterized as FDA approved, supported with evidence, lacking adequate evidence, or relatively contraindicated. Results: Prevalence of SSRI and similar product use was 20 per 1000 children aged 6 to 12 years, and 48 per 1000 children aged 12 to 18 years in the initial 6 month period. Use peaked for 6 to 12 year old children at a rate of 24 per 1000 in the last half of 2002, and for 12 to 18 year old children at a rate of 63 per thousand in the first half of 2004. In the first half of 2007, the prevalence of use was 16 per 1000 and 53 per 1000 for the younger and older age groups respectively. Since 2002, the proportion of SSRI products with minimal or no supporting evidence of safety or effectiveness in children increased from 20% to more than 45% of patient treatments. Conclusion: Decreases in use of SSRI and similar medications were seen among children covered by Arkansas medical assistance plans after FDA advisories were issued in 2003 and 2004. Additionally, young patients appear to be increasingly treated with SSRI and similar medications having minimal or no data supporting safety and effectiveness in children or adolescents.