The one thing that fills me with trepidation in my psychiatric practice is medicating children — only because mental health problems already come with a stigma in India; when there’s a need for medication, it can all appear alarmingly grave to parents and the patient. And even if that may not be a barrier, the fear of addiction and side effects can make many outside the medical profession jittery.

Understandably, medicating children for a mental, emotional or behavioural problem is never an easy decision. But knowing more about the process of prescribing, what medications do, and which conditions they can best help, can help ease the dilemma.

When is medicating children necessary?

In the early days of psychiatry, most emotional and behavioural disorders in children were blamed on faulty parenting (the parents of children with Autism Spectrum Disorders were even called refrigerator parents) and nasty environments. We, of course, now know this is false; a physiological cause has been found for most mental illnesses. Bipolar Disorder, for example, stems from a neurotransmitter imbalance in the brain, which medication can correct.

Psychotherapy should be the first intervention, but sometimes a mental illness may not respond to it and medicine is the only option left. For example, a child with an anxiety disorder who, after six months of regular talk therapy, still fears leaving his mother and going to school is probably in need of medicine. In a less common but more severe case, when a child is in danger of harming him or herself or others, he or she must immediately start appropriate medication.

For parents, with no medical training but lots of love and concern, it is difficult to discern the best line of treatment, even when receiving the advice of a professional. What if another doctor tells you differently?

It may help to know that medical professionals operate from a baseline (though a lot depends on the individual case) when it comes to medicating children: for adjustment disorders, anxiety disorders, or mild depression, talk therapy is recommended; for bipolar disorder, tic disorders, ADHD, psychotic disorders, or severe depression, medication is needed. For depression and ADHD, a combination of both therapy and medication is best.

How does medication work?

Medication acts at the level of the synapse (the space between two nerve cells) in the brain. Different drugs change the amounts of various neurotransmitters flowing between the nerve cells, which alleviate the symptoms of mental illness.

Most disorders requiring medication require it to be taken for around one year. During that year, it is important to take the medication as directed; there should be no reduction or increase of the dosage during times of stress like an exam, change of home, or death of a pet. The whole point of medicating children is to establish a typical, steady level of the correct neurotransmitter in their brain.

After a year, the dosage can typically be tapered and then stopped, under the supervision of a psychiatrist. A gradual taper is important to prevent withdrawal and to watch for any reemergence of symptoms.

Is mental health medication addictive?

Most prescription drugs do not have that effect. If symptoms recur when a child stops the medication, it doesn’t imply dependence. It simply means that the neurotransmitter balance has  not yet been achieved, and the child may need to continue the medication for a longer period.

ADHD medications are often touted as addictive, but studies have shown that children who take stimulants to treat their ADHD are at a reduced risk of substance use later in life.

Are there side effects? If so, how bad are they?

Medicating children for mental health problems can come with side effects, just as any medication can. The most common side effects are simple, reversible problems like acidity, sleeplessness, headache, and skin rash, which all tend to disappear over time. More serious side effects like movement disorders, suicidal thoughts and other life-threatening conditions are possible, though rare.

It is important to note that while there are warnings that antidepressants increase suicidal thoughts in 4% of children, it has not shown any increase in completed suicides among children. You can rely on the psychiatrist to weigh the risks and the benefits, and then prescribe.

How to get children to take their medicine?

Convincing kids to take their medication could be an uphill task, but it needs to be done, as irregular doses can be just as detrimental as no treatment at all.

Most kids worry that taking medication will change them in a fundamental way. They need to be reassured that medicines only target the symptoms and not their personality or intellect.

The best course of action is to explain their condition in medical terms without blaming them – for example, most children find it much easier to accept that they have a chemical imbalance rather than an emotional imbalance.

It can also help to give examples of other people who are on long-term medication. If you don’t know anyone personally, you can point to celebrities like Deepika Padukone and others who have been vocal about getting help for mental health struggles.

Does everyone need to know?

Not necessarily. If you think the school is going to look askance at the child taking medicine, you are not obliged to tell. In my practice, I have seen several schoolteachers of the mistaken opinion that mental illness is a matter of will-power and discipline, not only discourage kids from taking their ADHD medication but even forbid them to do so.

As a parent, you need to inform others only if it is in some way essential to protect your child. For instance, a depressed child could need help from his teacher to stop the class bully from hassling him.

Giving your child medication for mental illness often seems scarier than it needs to be. But with the help of the prescribing psychiatrist, and by involving your child, you can make an informed decision.