Prescribing for Children and Adolescents with Post-Traumatic Stress Disorder

Physicians are typically tasked with the critical role of making the most fitting clinical decisions when prescribing appropriate interventions for patients suffering from psychiatric disorders. The most common among these are FDA-approved medications, off-the label drugs, and non-pharmacological interventions; all of which can be prescribed in addressing post-traumatic stress disorder (PTSD) in children and adolescents. Such interventions seek to address patient’s trauma associated with a traumatic event with the ultimate aim of improving their quality of life by addressing their psychological distress. This discussion will evaluate Zoloft (Sertraline Hydrochloride), Pexeva (Paroxetine Mesylate), and hypnotherapy as highly recommended interventions in treating PTSD among children and adolescents.

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FDA-Approved PTSD Medication: Zoloft (Sertraline Hydrochloride)

            Zoloft, marketed generically as sertraline hydrochloride, is a selective serotonin reuptake inhibitor (SSRI) approved by the FDA and prescribed in the treatment o an assortment of mood disorders, chief among them being PTSD.  It is highly recommended by physicians due to its efficiency in improving mood, its inherent ability to reduce frequency of panic attacks, proven competence in minimize invasive thoughts, and balancing serotonin levels in the brain. It is taken by mouth in liquid or capsule form, with the dosage dependent solely upon the severity of symptoms.

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            Physicians are typically advised to consider the risks and benefits of Sertraline as a leading FDA-approved medication before prescribing it for use among children and adolescents suffering from PTSD. Perhaps the most fundamental risk posed by Sertraline use among minors is an overall elevation in impulsivity and suicidal ideations; facts that currently inform the placement of a “black-box” label warning on the drug by the FDA (Espinel & Shaw, 2018). The medication withdrawal symptoms associated with the drug may also worsen PTSD in children, triggering severe bouts of anxiety, agitation, and invasive thoughts. Yet, benefits associated with prescribing Sertraline in treating PTSD include attenuating symptoms associated with the condition after exposure to stressful events, an overall reduction in the frequency of flashbacks, and a higher likelihood of leading a return to normal life. American Psychological Association (APA) currently recommends use to range between 50 mg and 200 mg daily (American Psychological Association, 2019). This forms the basis of clinical practice guidelines for the use of Sertraline today.

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Off-Label PTSD Medication: Pexeva (Paroxetine Mesylate)

            Pexeva, marketed under generic name Paroxetine Mesylate, is a common off-label selective serotonin re-uptake inhibitor (SSRI) prescribed to treat PTSD and other manifestations common with anxiety disorders. It acts by restoring a state of equilibrium in the brain and using this chemical balance to promote an overall state of wellbeing in persons struggling with PTSD. Paxeva is taken either as an oral suspension or an extended-release tablet.

            Likewise, a risk assessment should always take precedence when prescribing Pexeva to children and adolescents with PTSD. As is common with off-label SSRIs, Pexeva is also associated with suicidal tendencies among minors and adverse changes in mood after prolonged use (Stein, 2016). Physicians prescribing Pexeva to minors are, therefore, required to communicate this fact to their patients and request them to seek immediate medical attention once noted as part of patient education. Additionally, prolonged use of Pexeva is associated with a high risk of seizures, coordination loss, agitation, and dizziness which may have an adverse impact on school-going children. Benefits of taking the drug in the treatment of PTSD are extensive. Patients typically report an improvement in their interest in daily life, an overall reduction in the frequency of panic attacks, and an elevation in energy levels. Clinical practice guidelines to optimize the efficiency of Pexeva in treating PTSD in minors includes understanding its interactions with pimozide, monoamine oxidase inhibitors (MAOIs) and thioridazine prior to prescribing the drug (Stein, 2016).

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Non-pharmacological intervention: Hypnotherapy

            Today, hypnotherapy is recommended as an ideal non-pharmacological intervention for children and adolescents that have undergone severe trauma linked to mental conditions such as PTSD. It is a form of guided hypnosis where a therapist serves as a conduit to an elevated state of consciousness; allowing the victim to revisit past events objectively and address their fears from the perspective of an altered state of mind.

            Taking the potential risks and benefits of incorporating non-pharmacological interventions such as hypnotherapy into account is often at the crux of its application when attempting to treat PTSD. The most common risk associated with hypnotherapy is the emergence of false memories, commonly referred to as confabulations, and an exponential increase in levels of anxiety (Bisson et al., 2020). However, hypnotherapy presents potential benefits as one of the most highly-recommended non-pharmacological evidence-based interventions for PTSD. Prolonged application of this particular intervention may guide patients to identifying the underlying cause of persisting symptoms, reduction in stress levels, and the subsequent titration of memories associated with a stressful life event (Kohen & Kaiser, 2017). Patients with the condition are, therefore likely to benefit a great deal from its application.

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