Pharmacologic management of posttraumatic stress disorder in children and adolescents*^¶

PTSD: posttraumatic stress disorder, SSRI: selective serotonin reuptake inhibitor.

* Our preferred first-line treatment for PTSD in children and adolescents is with trauma-focused psychotherapy. Refer to UpToDate content and associated algorithm for discussion of choosing trauma-focused therapy in children and adolescents with PTSD.

¶ We use pharmacologic management as an alternative initial treatment (in youth whose symptoms preclude trauma-focused therapy or require immediate attention).

Δ Refer to UpToDate content for discussion of initiation, titration, and maintenance treatment using prazosin in children and adolescents with PTSD.

◊ Refer to UpToDate content for discussion of initiation, titration, and maintenance treatment with guanfacine or clonidine in children and adolescents with PTSD. Choice of agent is based on preference, familiarity, and past history. We do not recommend the use of multiple noradrenergic modulator agents in the same patient.

§ Refer to UpToDate content for discussion of the choice, initiation, titration, length of therapeutic trial, and side effects of SSRI in the treatment of mood or anxiety disorders.

¥ The relationship between use of SSRI antidepressants and suicidal ideation is controversial. All SSRI have a boxed warning regarding the association with suicidal ideation. Further discussion of side effects of SSRI in children and adolescents are discussed elsewhere.