Trauma

Pharmacological Management of PTSD

How to Think about Medications for PTSD

As with many other disorders in child and adolescent psychiatry, the medications do not serve a curative role in PTSD treatment.Rather, they are used for two broad purposes:

• Alleviate particular disabling symptoms and comorbidities associated with PTSD, such as emotional hyperarrousal, sleep disturbances, anxiety, irritability, and anger outbursts, with goals to restore functioning and return to normal developmental trajectory.
• To assist the child undergoing a psychotherapeutic intervention in dealing with and processing of traumatic and emotional content.

Which Medications Are Used for PTSD

• Use of SSRIs is supported by substantial body of evidence in adult PTSD; SSRIs have been shown to improve symptoms in each of the three symptom categories. Pediatric studies of SSRIs for symptoms of PTSD are scarce, and their clinical use is extrapolated from adult literature. Thus, careful monitoring and balancing known risks and potential benefits of SSRIs use are necessary.
  
• Alpha-2 adrenergic blockers, such us clonidine and guanfacine, have been used successfully to relieve symptoms of hyperarrousal and impulsivity. Guanfacine may help with PTSD-associated nightmares.

Antipsychotics have been used in adults with PTSD. While they are used widely in many pediatric disorders, their efficacy in pediatric PTSD had not been investigated. Antiepileptics may also have a role in PTSD symptom relief, but research into their efficacy is lacking as well.
Nefazodone and imipramine, medications that have been used successfully in adult PTSD, are not used in children. The evidence for their efficacy is either anecdotal or contradictory. Adverse effects, particularly hepatotoxicity of nefazodone, leave little justification for the use of these drugs in pediatric PTSD.

Further Reading

Stamatakos M, Campo JV. Psychopharmocologic treatment of traumatized youth. CurrOpinPeds 2010; 22:599
Horrigan J. Guanfacine for PTSD nightmares. JAACAP 1996; 35:1247