Updated: Oct 1, 2021
The Role of Physicians and Medication in Treating Trauma
Judith Aronson-Ramos, MD
As a community that experienced significant trauma, Parkland and its families carry a heavy burden. The tragedy at MSD is a legacy we inherited. Awareness and understanding of trauma and its effects on all of us can be a means to develop resilience and strength This will help us navigate current (pandemic) and future (climate change, pervasive gun violence, etc.) traumas.
From a medical perspective, children and teenagers are subject to complications from trauma in ways both similar and different to adults. Research shows the pediatric age group may be more sensitive to the effects of trauma. This largely depends on when in their development the adverse events occur, the duration of the exposure, and access to supportive care. Children and teens do not have the same access to help and treatment adults do. Children are often deemed “resilient” or “they’ll bounce back quickly” after a trauma, however the wound runs deep.
Parents, therapists, teachers, and others who are in close contact with children and teens have a vital role to play in helping identify and support children who need treatment and care. Therapy in its different forms is well recognized in our community to treat trauma since the tragedy at MSD. As a physician I would like to focus on medication where there is less data and less consistency in care.
Due to children and teens youth, they are not researched as thoroughly as adults. This has led to a lack of well conducted randomized clinical trials to guide physicians and standardize treatment for trauma in pediatrics. This results in a wide range of treatment strategies and inconsistency in medical approaches. In general, however, there is broad agreement in the treatment of the psychiatric disorders and symptoms we can see because of trauma – anxiety, depression, hyperarousal, impulsivity, psychosis, aggression, irritability, insomnia, and mood instability.
A step wise approach to the use of medications when indicated for symptoms resulting from trauma including PTSD is the most effective. This means treating the most impairing symptoms first and using medication as needed to address these symptoms. For example, reduction in a significant symptom such as insomnia can have a pervasive effect on overall functioning. If insomnia is treated effectively, it can improve numerous other problems exacerbated by this one symptom including attention, impulsivity, mood, etc. Treating this symptom first may then result in improvement in other areas.
Individualizing treatment to address the most troubling symptoms, which differ for each individual child, will result in the most successful outcome. This means as a physician taking a good thorough history, and as a parent providing that information in a clear and concise manner. Teachers and therapists have a role to play as well providing additional clinical information to parents and or physicians to help guide treatment. A comprehensive approach such as this, will provide the greatest chance of clinical success.
There is no specific medication for trauma. As far as the general classes of medications used the most common are the SSRIs (Prozac, Zoloft), alpha adrenergic agents (Clonidine, Guanfacine), and atypical antipsychotics (Risperdal, Abilify) being the most common. When considering medication as a treatment the discussion should include prioritizing target symptoms (most impairing problems) and then use the appropriate medication for that concern. Keep in mind medication alone should never be the treatment of choice. Medication and therapy combined is far more effective.
There are many situations where therapy is the most effective intervention and medication is not helpful. Additionally, there should always be a thorough history of lifestyle conditions which impact psychological functioning – nutrition, exercise, social outlets, school, and general tenor of home life. There may be helpful interventions in all of these areas which can be highly impactful. Healthy eating, regular exercise, reducing isolation, school supports all have powerful roles to play in the healing process.
In sum, medications have a role to play in the treatment of trauma, but medication alone is never enough. There should always be a comprehensive treatment approach where medication is seen as one tool of many to help a child/teen overcome the impairment from their traumatic experience.
Oral, R., Ramirez, M., Coohey, C. et al. Adverse childhood experiences and trauma informed care: the future of health care. Pediatr Res 79, 227–233 (2016). https://doi.org/10.1038/pr.2015.197
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