Pharmacotherapy for survivors of childhood trauma

Research over the past decade and a half has established the efficacy of pharmacotherapy as an important adjunctive treatment for trauma in conjunction with either cognitive behavior therapy or psychoanalytic psychotherapy. Medication is often effective in reducing post-traumatic stress symptoms as well as treating a number of commonly comorbid conditions such as depressive and anxiety disorders. The current medications of choice are the selective serotonin reuptake inhibitors (SSRI), which are beneficial for posttraumatic reexperiencing, hyperarousal, and avoidant symptoms. Other medication classes including non-SSRI antidepressants, mood stabilizers, anticonvulsants, and anti-adrenergic agents have shown efficacy for some trauma symptoms. Because beneficial responses may be slow to appear, pharmacotherapy of trauma requires a medication trial of adequate length and dose to determine effectiveness. Partial responders may require the addition of a second class of medication. Positive responders should be maintained on medication for at least 6 months after remission of acute PTSD and at least 12 months after remission of chronic PTSD. The initial successes of pharmacotherapy for trauma are spurring further research and more effective medications can be anticipated in the foreseeable future.