Antidepressant pharmacotherapy in childhood PTSD with and without comorbid ADHD: a nationwide retrospective study

Post-traumatic stress disorder (PTSD) and attention deficit hyperactivity disorder (ADHD) are prevalent in youth, with psychotherapy as the first-line PTSD treatment and stimulants as the primary ADHD treatment. However, antidepressants are commonly prescribed to manage comorbid internalizing (depression, anxiety, and irritability) symptoms seen in patients with both disorders. Despite the high occurrence and complexity of comorbid PTSD with ADHD, little empirical data exist on antidepressant use in youth with PTSD, and particularly in youth with co-occurring externalizing disorders.

This retrospective cohort study utilized the U.S. TriNetX database, examining 83,252 records of children and adolescents under 21 with PTSD. Of these, 37,003 (44.4 %) also had ADHD (PTSD-ADHD), and 46,249 (55.6 %) had PTSD alone. We compared the prevalence of SSRI and SNRI prescriptions and the progression of antidepressant treatments in both cohorts.

Youth with PTSD-ADHD were more likely to be prescribed SSRIs than those with PTSD alone (OR 1.24, p < 0.05). When matched by age, sex, race, and ethnicity, the PTSD-ADHD cohort had higher rates of SSRI (OR 1.45, p < 0.05) and SNRI (OR 1.33, p < 0.05) use. After PTSD diagnosis, 60.4 % of the PTSD-only group and 42.3 % of the PTSD-ADHD group did not initiate antidepressants (p < 0.001). Among those prescribed antidepressants, 81.54 % of the PTSD-only and 74.72 % of the PTSD-ADHD group remained on the initial medication without switching to other medications (p < 0.001).

Youth with PTSD-ADHD are more likely to be prescribed and switch antidepressants than those with PTSD alone, emphasizing the need for further research into treatment mechanisms in this population.