Paroxetine has been associated with increased rates of suicidality in adolescents treated in antidepressant clinical trials. Regulatory agencies in the United States and the UK have issued warnings that are already changing clinical practice for adolescents. In a pilot analysis, we characterized the extent of risk by investigating paroxetine-associated suicidality in a related high-risk population, younger and adult individuals with bipolar disorder whose rate of suicide attempts approaches 2 percent per year. A cross-sectional survey and cohort analysis of 1,000 patients followed for at least 1 year under naturalistic conditions in the NIMH-funded STEP-BD network revealed no association of paroxetine with suicidality in those less than or at least 21 years of age. In fact, the younger group showed a trend for decreased suicidality (P = .13). Thus, increased suicidality risk with paroxetine exposure does not extend to this other high-risk mood disordered population, even among younger individuals.