OBJECTIVES: The aim of the study is to determine the impact of black box warning and other regulatory changes related to antidepressants on the prescription pattern of antidepressants for children and adolescents by office based physicians. METHODS: Data for the present study was obtained from National Ambulatory Medical Care Survey (NAMCS), 2003-2005.  Patients under the age of 18 were included in the study, if they had at least one antidepressant prescribed. Prescription pattern of antidepressant was assessed in terms of rate of antidepressants prescribed, type of antidepressants, physician specialty and demographics such as age, gender and race. Descriptive statistics were carried out using SPSS 17. RESULTS: The number of visits with at least one antidepressant prescribed for children and, adolescents were 228 (10.37%), 213 (9.23%) and, 184 (6.81%) for year 2003, 2004 and 2005 respectively. Rate of prescribing Fluoxetine per 100 antidepressants increased from 17.16 in 2003 to 19.13 in 2004 and 26.26 in 2005, rate of prescribing Paroxetine decreased from 17.91 in 2003 to 11.30 in 2004 to 11.11 in 2005. The number of antidepressants prescribed by psychiatrists decreased from (186, 81.6%) in 2003 to (164, 77%) in 2004 and (135, 73.6%) in 2005. CONCLUSIONS: The rate of prescribing antidepressants to children and adolescents decreased after FDA black box warning in 2004. The prescription rate of Fluoxetine increased after FDA approved it for children and adolescents in 2004 while prescription rate of Paroxetine decreased after 2003 when FDA recommended that it shouldn’t be used in pediatric patients. No changes were observed in antidepressant prescribing by primary care physicians.