Jeremy had been seeing another child psychiatrist for the last year before he visited my office. He initially started treatment after his family noted increased irritability in the home, falling grades, withdrawal from his friends, worrisome posts on social media, and a decision to quit the school swim team (a sport that he was particularly good at and was potentially going to pay his way through college). His treating child psychiatrist had appropriately diagnosed Jeremy with depression (in children irritability is often seen as the primary symptom rather than depressed mood)—and had started him on Prozac (Fluoxetine), an SSRI antidepressant that is the most studied antidepressant in children and FDA approved for this indication. According to the textbooks, this was the correct choice. For the subsequent six months, the dose was slowly increased, yet Jeremy’s symptoms got worse. Anger outbursts emerged and he had internalized that he was a bad child, often commenting that he wished he was never born. Ultimately, after he relayed to a friend that he was thinking about hurting himself, the school counselor was informed, and Jeremy was sent to a partial hospital program. While there, he was switched to an alternative SSRI antidepressant, Zoloft (Sertraline), and its dosage was slowly increased for the subsequent three months until his nausea was so great that they could not increase further.