Treatment options for pediatric PTSD and trauma symptoms are limited, and the symptoms are clearly detrimental to youths’ functioning, particularly in the presence of comorbid disorders. As recommended treatments, trauma-focused cognitive behavioral therapy (TF-CBT) and SSRIs rarely leadto a quick remission of symptoms, so child psychiatrists are in need of a larger pharmacologic toolbox.
A recent open-label pilot study was conducted investigating the tolerability and effectiveness of guanfacine XR (GXR) for children and adolescents with trauma symptoms, including re-experiencing, avoidance, and hyperarousal. (This study was sponsored by Shire Pharmaceuticals, the makers of Intuniv, a branded version of guanfacine.)
Seventeen subjects were enrolled, having been recruited through psychiatrists’ offices, advertisements,or word of mouth. Inclusion criteria included being six to 18 years old, having trauma symptoms as measured by standard rating instruments, and being free of other psychotropic medications.
Children were allowed to have comorbid conditions, and many did: 89.5% met criteria for ADHD, 68.4% for PTSD, 47.4% for GAD, 21.1% for depression, 10.6% for separation anxiety disorder, and 5.3% for reactive attachment disorder.
Subjects were started on 1 mg of GXR at bedtime during week one, which was titrated as needed by 1 mg weeklyto maximum dose of 4 mg/day by week five. Thirteen of the original 17 children completed the trial, with an average does of GXR of 1.19 mg/day over the course of the 8 week trial. Four dropped out due to worsening depression, side effects (sedation/fatigue), lack of effectiveness, and transportation issues.
How well did the treatment work? Pretty well. Thirteen children completed the treatment: 70.6% were rated by clinicians as very much improved or much improved on the CGI, and 82.4% showed a greater than 30% reduction on the UCLA-RI, a measure of PTSD. Subjects also reported significant improvements in hyperactivity and inattention aswell as anxiety symptoms. At study conclusion, 12 of the original 17 elected to continue GXR treatment (Connor D et al, J Child Adolesc Psychopharmacology 2013;23:244–251)
CCPR’s Take: Generalizability of these results is limited because this was not a double blind trial and the sample size was small. Nonetheless, given the paucity of treatment options for pediatric PTSD, low dose guanfacine—either as the branded XR or the cheaper immediate release generic—may be worth a try.
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