Psychopharmacology for Pediatric PTSD

The evidence base for psychopharmacological treatment of post-traumatic stress disorder (PTSD) in children/adolescents remains limited. Trauma-focused cognitive behavioral therapy (TF-CBT) remains the best studied treatment and whenever possible should be employed before starting medications. Unfortunately, children/adolescents often present with severe PTSD symptoms that may persist even after an adequate course of TF-CBT and may require a pharmacological approach. When medications are required, based on available evidence and clinical experience, we recommend that first-line treatments include SSRIs (citalopram, fluoxetine) and antiadrenergic agents (prazosin, guanfacine, clonidine). Other treatment options include propranolol, second-generation antipsychotics (risperidone, quetiapine), and mood stabilizers (carbamazepine, divalproex sodium).