Pharmacological Treatment for Children and Adolescents with Trauma-Related Disorders

Remarkably, there are currently no guideline-recommended, evidence-based pharmacological treatment strategies for child and adolescent posttraumatic stress disorder (PTSD), with trauma-focused cognitive therapy, the main pillar of treatment. In the present chapter, we focus on presenting insights into the limited research examining the efficacy of pharmacotherapy within four classifications: selective serotonin reuptake inhibitors (SSRIs), second-generation antipsychotics, mood stabilizers, antiadrenergic medications, and other further agents. SSRIs function as the most widely used pharmacological treatment for trauma-exposed adolescents due to their demonstrated effectiveness in the adult population, relative tolerability, minimal side effects, and broad application to a variety of mood and anxiety symptoms. While certain medications within the antidepressive, antipsychotic, antiadrenergic, and anticonvulsant classifications have demonstrated positive results in open-label trials (like prazosin, guanfacine, citalopram, carbamazepine, risperidone, quetiapine), these medications have yet to stand up to the rigors of randomly controlled trials and, as such, should be targeted for future exploration. Following a discussion on the theoretical and research underpinnings of therapies along with an outlook on new therapeutic avenues, the treatment of patients is discussed: PTSD and a comorbid condition, an atypical presentation, a treatment-resistant presentation, acute medication options for PTSD, and psychopharmacological side effects in a patient with PTSD.