Psychopharmacologic treatment of posttraumatic stress disorder in children and adolescents: a review.
OBJECTIVE
Despite the high prevalence and significant morbidity associated with posttraumatic stress disorder (PTSD) in children and adolescents, there are limited and conflicting data to guide psychopharmacologic interventions. With these considerations in mind, we sought to summarize the current evidence for psychopharmacologic interventions in youth with PTSD.


METHODS
We conducted a literature review of the National Library of Medicine to identify publications of pharmacologic treatments for youth with PTSD or posttraumatic stress symptoms. The search was limited to articles written in English and published between 1966 and 2009. In addition, we manually searched each citation for additional references and the following journals: Journal of the American Academy of Child and Adolescent Psychiatry and the Journal of Child and Adolescent Psychopharmacology.


METHODS
All articles were manually reviewed and evaluated. Thereafter, each agent or class of medication was categorized by level of evidence.


RESULTS
Three double-blind, randomized controlled trials of selective serotonin reuptake inhibitors (SSRIs) and 1 double-blind randomized controlled trial of imipramine in children and adolescents with PTSD or acute stress disorder were identified. Additionally, several open-label studies and case series involving other classes of medications (eg, antiadrenergics, other antidepressants, and second-generation antipsychotics) were reviewed.


CONCLUSIONS
The extant data do not support the use of SSRIs as first-line treatments for PTSD in children and adolescents. There is limited evidence that the brief use of antiadrenergic agents, second-generation antipsychotics, and several mood stabilizers may attenuate some PTSD symptoms in youth. However, controlled trials of these agents in children and adolescents with PTSD are needed.
Strawn
Jeffrey R
JR
University of Cincinnati, Dept. of Psychiatry, Cincinnati, OH 45267-0559, USA. strawnjr@uc.edu
Keeshin
Brooks R
BR
DelBello
Melissa P
MP
Geracioti
Thomas D
TD
Putnam
Frank W
FW
D000293:Adolescent; D018674:Adrenergic Antagonists / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002648:Child; D003430:Cross-Sectional Studies; D004311:Double-Blind Method; D006801:Humans; D007099:Imipramine / Q000627:therapeutic use; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology
D018674:Adrenergic Antagonists; D000929:Antidepressive Agents, Tricyclic; D014150:Antipsychotic Agents; D007099:Imipramine; D011619:Psychotropic Drugs; D017367:Selective Serotonin Reuptake Inhibitors