Children with major depression recover best with medication and cognitive behavioral therapy, which teaches problem-solving and helps fight negative thoughts, says one expert.

The firm Verispan reports a 20% fall in prescriptions from January 2002 to July 2005 in its analysis for the FDA, says Paul Seligman, chief of FDA post-marketing drug surveillance.

There's a 25% decline since January 2003 in an analysis for USA Today by Medco Health Solutions, pharmacy benefit managers whose figures cover privately insured families and are skewed to the middle class.

Black Box Labels

At a peak, nearly 11 million antidepressant prescriptions were written for US children in 2002. A series of safety warnings in 2003 culminated with the FDA ordering "black box" labels, the most severe warning, for the drugs last October. About two out of 100 kids become more suicidal because of the pills, the FDA said.

Two other prescribing trends could signal a new climate of caution among doctors. Prescriptions fell 32% for kids under 12 vs. 18% for those 12 to 18 in the FDA analysis.

There's more research on antidepressants in adolescents than younger children. Also, prescriptions increased for Prozac, the only drug approved for childhood depression, so fewer doctors are prescribing medicines not certified for kids.

Trend Could Backfire?

"The black boxes definitely added to parents' fears, and many doctors didn't appreciate the risks before," says behavioral pediatrician Lawrence Diller of Walnut Creek, Calif.

But the trend could backfire, warns child psychiatrist David Fassler of Burlington, Vt. Teen suicides fell by one-third from 1990 to 2002, "and I worry what we're going to see now."

Children with major depression recover best with medication and cognitive behavioral therapy, which teaches problem-solving and helps fight negative thoughts, says Duke University child psychiatrist John March. Most with milder depressions recover on their own or with therapy, he says.

There's been no unusual increase in kids entering therapy in the past few years, says Jerry Vaccaro of PacifiCare Behavioral Health in Van Nuys, Calif.