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We describe the first four cases of an open-label study investigating the response to citalopram in a depressed pediatric oncology population. Advice from the Committee for Safety of Medicines (CSM) in the United Kingdom warning against the use of serotonin-selective reuptake inhibitor (SSRI) antidepressants other than fluoxetine in this age group led to the discontinuation of the study. Advantages of citalopram over fluoxetine in a medical setting are discussed in terms of its favorable drug-interaction profile and shorter half-life. Citalopram was very well tolerated in these patients and preliminary data are presented that support its efficacy as an antidepressant agent in these patients.