OBJECTIVE: Prevalence of Major Depressive Disorder (MDD) ranges from 3% to 8% in children and adolescents. Numerous antidepressants exist, but only fluoxetine is indicated for pediatric MDD. Recent federal acts require pharmaceutical companies to evaluate efficacy and safety of products in pediatric populations. However, to most effectively treat their pediatric patients, physicians will use the best available resources even if it means prescribing antidepressants off-label. In light of recent warnings and concerns regarding antidepressants in pediatric populations, the purpose of this study is to examine use of anti-depressants, prescriber specialties prescribing antidepressants and persistency of antidepressants in children and adolescents. METHODS: Using a geographically diverse and representative prescription database, patients between 5 and 17 years of age who filled a first prescription for an antidepressant between July 21, 2001 and April 19, 2002 were identified and grouped as children (5-11 years) or adolescents (12-17 years). Antidepressants were categorized by drug class: tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitor (SSRI/SNRI) and newer generation antidepressants (NGAD). Prescribers were categorized by specialty: psychiatrists, pediatricians, primary care physicians (PCPs), and other. RESULTS: There were 100,280 children (64.1 % males) and 237,236 adolescents (45.3% males). Among children and adolescents, 54.5% and 67.3%, respectively, of new product starts were for an SSRI/SNRI; only 21.4% and 23.3%, respectively, started on fluoxetine. For children and adolescents, psychiatrists were least likely to prescribe a TCA. Psychiatrists and pediatricians were most likely to prescribe SSRI/SNRIs to children; PCPs and pediatricians were most likely to prescribe SSRI/SNRIs to adolescents. For children and adolescents, persistency was longest for SSRI/SNRIs. CONCLUSIONS: These results indicate that in pediatric populations there is either considerable off-label use of anti-depressants or that these products are used for indications other than MDD. These results have risk management implications and may facilitate further investigation of pediatric antidepressant use.