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SCCM: Acute Stress Disorder in Severely Burned Children Improves with Pharmacologic Treatment By Jill Stein Special to DG News SAN ANTONIO, TX -- January 31, 2003 -- Investigators are recommending early treatment of acute stress disorder with imipramine or fluoxetine in children who have sustained a major burn. The researchers, from Shriners Hospital for Children in Galveston, Texas, made their recommendation here January 31st at the Society of Critical Care Medicine's 32nd Critical Care Congress. Dr. Walter J. Meyer reported results in 72 children with acute stress disorder resulting from acute burns treated with imipramine and 18 treated with fluoxetine. Subjects ranged in age from five to 17 years. Nearly 90% of children responded to one or the other medication and that the response usually occurs within three days, Dr. Meyer said. Initially, the only treatment that was offered was imipramine at a dose of 1 mg/kg. In 1999, fluoxetine began to be offered at a dose of 5 to 20 mg depending on weight. If significant improvement did not occur within one week, the patient was switched to the other medication. Overall, 81.9% of patients responded to initial imipramine treatment. Of the 13 patients who failed initial imipramine treatment, three patients received a second treatment. Five of the patients who initially failed imipramine responded to an increased dosage of the drug, and three responded to fluoxetine. Twelve patients responded to initial treatment with fluoxetine (66.7%). Of the six patients who did not, five responded to imipramine as a second treatment. Ten patients who failed imipramine refused other medication. The side effects related to each medication were mild, Dr. Meyer said. Most patients remained on treatment for at least three months before any attempt was made to discontinue therapy, and most patients needed six months of treatment before successful discontinuation. A higher percentage of patients with smaller burns responded better than those with larger burns, and younger patients were more likely to respond than older patients. Boys and girls responded at a similar rate. The symptoms of acute stress disorder -- dissociation, flashbacks, avoidance behavior, emotional numbness, hyper-arousal, and nightmares -- occur one month post-trauma. E-mail this page to a friend or colleague! To print, use this version