As the Food and Drug Administration considers warning labels for some antidepressants, Dr. Michael Sorter, director of the division of psychiatry at Cincinnati Children's, says parents and therapists need to know more about the pros and cons of using medications such as Paxil to treat depression in teenagers.

Last week, an advisory panel urged the FDA to add warning labels to certain antidepressants because of concerns they might increase suicidal or violent thoughts.

Depression is a life-threatening illness, Sorter says, and psychotherapy is often needed along with medication.

Question: How would you sum up the FDA advisory panel's concerns?

Answer: There have been some indications that there may be some increase in suicidal thoughts when youth are treated with antidepressant medications.

It should be noted that in all the clinical trials there was never a completed suicide. But there may be some increased thoughts about suicide or minor actions.

And there are also some concerns from families whose sons or daughters tragically completed suicide during the course of treatment, so there may be a heightened concern that there could be a relationship.

Question: Do you think the "black box" label (the FDA's strongest and most visible warnings on medications) should be added to SSRI (selective serotonin reuptake inhibitors, which stabilize serotonin levels)?

Answer: I think that there are two issues here.

One is there needs to be an increased awareness of the benefits of antidepressant medications, and two, there needs to be increased awareness of what the dangers can be. My concern about going to the black box-type warning is that this would really have a negative effect in scaring away people from seeking treatment and scaring away some people from providing it.

Q: What are the concerns for prescribing selective serotonin reuptake inhibitors, which stabilize serotonin levels, to teens to treat depression?

A: When you engage a young person who's depressed in treatment, it's really a significant alteration in their life. It's a time when they're probably the most highly stressed they've ever been. It's often a family in crisis and there's a very heightened awareness that something is wrong. So a lot's happening at once. With the questions about the medications, how much of the risk is the role of medications and how much is the role of this increased attention? We really don't know yet. We need more research into the idea of, 'do these medications really promote in a strong way any kind of self-destructive impulses?' That really is not clear. That's what we need to find out. And maybe somehow we could predict who would have a good response and maybe who would have a negative response.

Q: Has there been any discussion at Children's of changing prescription practices?

A: I would say for us, it's probably a little easier to proceed, the reason being that because there's a shortage of child and adolescent psychiatrists, usually the kids who make it to us are often more severe cases. We also have a clear realization that medication is only one part of a treatment plan. In involves not only individual work with a child, but family work, education, perhaps intervention with the school, and really looking at a plan to help the child improve their function with friends, family, school and social functions, and putting into place a follow-up plan.

Q: What advice do you have for parents whose children are taking SSRIs?

A: First, don't make abrupt changes. Work with your physician and your treating therapist, if there is one involved, and begin the discussion. A lot of people have done well on medications like Paxil and Effexor and we don't want to go into a rapid swing and change things. But engage in this discussion with the clinician.You also need to make parents aware that just because treatment has started, treatment hasn't ended, and they need to connect with their young person and try to establish a rapport.

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