A necessary warning.

Byline: The Register-Guard

Who can blame frightened, anxious parents for hoping that a miracle drug might be able to cure their dangerously depressed adolescents?

These parents undoubtedly have heard of - and some have likely experienced - the success of antidepressant medications in treating adult mental health conditions ranging from panic attacks to bipolar disorder. There is undeniable comfort for physicians as well as their patients in the concept of depression yielding to Prozac in the way headaches respond to Tylenol.

But not only are the causes of mental pain more elusive than the sources of physical discomfort, children and adults often differ dramatically in their responses to medication. In the case of antidepressants, there is accumulating evidence that drugs such as Prozac, Paxil and Zoloft may increase the risk of suicidal thoughts and behaviors for perhaps 2 percent to 3 percent of children younger than 18.

Faced with this potential risk, the Food and Drug Administration should follow the recommendations of its advisory panel and order strong "black box" warnings to appear on antidepressant labels. These alerts would be published in bold type and surrounded by a prominent black border.

In addition, the FDA should require that a pamphlet explaining the risks in patient-friendly language be handed out with every prescription.

This is an agonizing choice, fraught with complications. If the FDA requires new warning labels, some physicians may stop prescribing antidepressants for adolescents. Left untreated, adolescent depression also carries a suicide risk.

Moreover, the data studied by the FDA panel are far from conclusive. And many health professionals have had demonstrable success treating adolescent depression with Prozac, the only antidepressant specifically approved for use with patients younger than 18. (Even Prozac, however, has been linked to increased suicidal thoughts and behaviors in adolescents.)

But the FDA panel noted that researchers still have questions about the effectiveness of antidepressants in children and adolescents, and the available studies are inconsistent. More important, parents and physicians testified that they did not have clear information about the risks, and that such information could have influenced their decisions to use the drugs.

To the extent that antidepressants are overprescribed to adolescents as a quick fix for teenage - and parental - angst, more caution will be welcome. Properly cautioned, parents will know to pay close attention to children taking the drugs.

But the FDA panel's recommendations serve to underscore recent research that indicates combining drugs with talk therapy is the most effective approach to treating depressed adolescents. Having a teenager working closely with a professional counselor who is familiar with these medications and their risks offers the best hope for a favorable outcome.