Use of antidepressants by children continued to drop sharply this year in the wake of warning labels linking the prescription drugs to suicidal behavior, according to market analyses.

The decrease signals that doctors and parents are taking a more careful look at benefits and risks of treatments for depression, says child psychiatrist David Fassler of Burlington, Vt. "Not all depressed kids need medication. There are effective therapies, especially for milder forms of depression."

The Food and Drug Administration ordered "black boxes," the most severe safety warning, for antidepressants in October 2004, and these stronger labels were on the medicines by March. The FDA said two out of 100 children were more likely to think about or try suicide because they were taking the pills.

There has been a 25% drop in pediatric prescriptions for antidepressants since the FDA started issuing safety warnings in 2003, according to a September analysis by Medco Health Solutions, pharmacy-benefit managers. About a 20% overall drop is reported by NDC Health Inc. from March 2004 to June.

At a peak in 2002, nearly 11 million antidepressant prescriptions were written for U.S. children, the FDA says.

The long-term effect of the drop on children's mental health, if any, is unknown. Teen suicides fell by a third from 1990 to 2002, "and I hope this won't be reversed because parents or doctors are afraid to use the medicine when it's needed," Fassler says.

"We'll need to continue monitoring the situation closely over coming months and years," he says. "The most important question is not how many are taking antidepressants, but whether or not kids are getting the most appropriate treatment possible."