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Pharmacotherapy in Pedatric PTSD: A Developmentally-Focused Review of the Evidence

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After the experience of a traumatic event, children and adolescents are especially vulnerable to developing debilitating symptoms of Posttraumatic Stress Disorder (PTSD). Criteria for diagnosing this disorder in the pediatric population have proven insufficiently sensitive for children, especially those who are very young. Age-related PTSD symptom expression suggests PTSD assessment and treatment requires developmental consideration. Preschool age children, school age children, adolescents, and adults also possess potentially distinct differences from one another in pharmacokinetics, psychosocial influences, and neurobiology. Pharmacotherapy is often indicated for use in the treatment of pediatric PTSD. Extrapolation of evidence in adult literature for safety, tolerability, and efficacy is nonlinear and should not substitute for dedicated drug trials in pediatric PTSD. This paper reviews all identified randomized controlled trials (RCTs), uncontrolled and open label trials, and case reports/series regarding pharmacotherapy in this population. Emphasis is placed on methodologic rigor and developmental consideration. These trials are discussed in sufficient detail to inform readers of their relative strengths and weaknesses, and of the generalizability of the studies’ conclusions. This review summarizes reports by drug class and developmental cohorts (preschool age, school age, and adolescents). The review will help clinicians a) decide when medications are needed, b) understand current evidence-based alternatives and c) utilize a developmental approach in the selection of medication.
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Keywords: Adolescents; Antiepileptics; Beta-Blockers; PTSD; Quetiapine; Tricyclic Antidepressants (TCAs); UCLA PTSD-I; children; development; hyperarousal; medication; or AEDs; pediatric; pharmacotherapy; propranolol; review

Document Type: Research Article

Publication date: August 1, 2012

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  • Current Psychopharmacology publishes peer-reviewed expert review articles and single topic guest edited issues on all aspects of pre-clinical and clinical research in psychopharmacology. The journal aims to be the leading forum for expert review articles in the field. The journal also accepts high-level original research articles on outstanding topics of preclinical and clinical psychopharmacology. Data must be published for the first time in Current Psychopharmacology.
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