Review finds insufficient evidence for routine PTSD medication in youth

Traumatic events are common during childhood and adolescence and may lead to acute stress disorder (ASD) or post-traumatic stress disorder (PTSD), both associated with developmental, cognitive and functional impairment. Although trauma-focused psychotherapies are recommended as first-line treatments, pharmacological interventions are frequently used in clinical practice despite limited evidence in paediatric populations. To review the evidence on pharmacological interventions for the prevention and treatment of paediatric ASD and PTSD, we reviewed the literature published up to December 2025. Eligible studies included participants aged younger than 18 years and evaluated pharmacological interventions targeting ASD, PTSD prevention or PTSD treatment. After screening and a full-text review, 75 publications were included. Given the methodological heterogeneity, findings were synthesised narratively. Evidence for pharmacological interventions in paediatric trauma-related disorders remains limited and heterogeneous. For PTSD prevention, only limited data support sertraline and, in the context of ASD, imipramine. Limited data also suggest that opioids used for pain management after trauma may reduce subsequent PTSD risk. Early opioid (morphine) exposure for pain management was also associated with lower subsequent severity symptoms in observational paediatric burn studies. Evidence for PTSD treatment is weaker. Anticonvulsants (sodium valproate, carbamazepine, oxcarbazepine, lamotrigine), antipsychotics (clozapine, quetiapine, aripiprazole), glutamatergics (D-cycloserine, ketamine, ifenprodil), propranolol and cannabidiol do not appear to provide sufficient benefit for routine use. Alpha-adrenergic agents (prazosin, clonidine, guanfacine) have shown preliminary signals of benefit, particularly for hyperarousal and trauma-related sleep disturbances. However, these findings are based on non-randomised and uncontrolled studies. Antidepressants (sertraline, citalopram) show mixed results; among them, citalopram was associated with symptomatic improvement in one small open-label study and one case series. These findings should be considered preliminary and hypothesis generating. No pharmacological treatment has sufficient evidence to warrant routine recommendation for paediatric PTSD and ASD. Pharmacotherapy should therefore be considered only as an adjunct to trauma-focused psychotherapy in selected clinical situations. Further randomised controlled trials are needed.