From the Guidelines
Valazodone should be considered as a treatment option for major depressive disorder in adults, with a strong recommendation to select second-generation antidepressants based on adverse effect profiles, cost, and patient preferences, as stated by the American College of Physicians 1.
Key Points to Consider
- Valazodone is a serotonin modulator that increases serotonin levels in the brain and partially activates certain serotonin receptors.
- The usual starting dose is 10 mg once daily, gradually increased to 20-40 mg daily over several weeks, and should be taken with food to improve absorption.
- Common side effects include nausea, diarrhea, dizziness, and insomnia.
- Patients should be aware of the black box warning regarding increased suicide risk, particularly in young adults and adolescents, especially during the first few weeks of treatment.
- Valazodone can interact with MAOIs and other serotonergic medications, potentially causing serotonin syndrome, so patients should inform their healthcare provider about all medications they're taking.
- Abrupt discontinuation should be avoided; the dose should be gradually tapered to prevent withdrawal symptoms.
- Valazodone typically takes 2-4 weeks to show therapeutic effects, so patients should continue taking it as prescribed even if they don't notice immediate improvement.
Recommendations
- Clinicians should select second-generation antidepressants, including valazodone, based on adverse effect profiles, cost, and patient preferences 1.
- Patients should be assessed regularly for therapeutic response and adverse effects, starting within 1-2 weeks of initiation of therapy 1.
- Treatment should be modified if the patient does not have an adequate response to pharmacotherapy within 6-8 weeks of initiation of therapy for major depressive disorder 1.
- Clinicians should continue treatment for 4-9 months after a satisfactory response in patients with a first episode of major depressive disorder, and consider longer durations for patients with multiple episodes of depression 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Valazadone Overview
- Valazadone is not mentioned in the provided studies, it is possible that the correct term is Vilazodone.
- Vilazodone is a selective serotonin reuptake inhibitor (SSRI) and serotonin 5-HT1A receptor partial agonist, approved for the treatment of major depressive disorder (MDD) in adults 2, 3, 4, 5, 6.
Mechanism of Action
- Vilazodone works by enhancing serotonergic activity in the central nervous system through selective inhibition of serotonin reuptake and partial agonism of the 5-HT1A receptor 2, 3, 4, 5.
- This mechanism of action is unique compared to other antidepressants, allowing for a faster onset of action and improved tolerability 2, 3, 4, 5.
Efficacy and Safety
- Vilazodone has been shown to be effective in reducing symptoms of MDD in several clinical trials, with significant improvements in depressive symptoms compared to placebo 3, 4, 5, 6.
- The most common adverse events associated with vilazodone are diarrhea, nausea, vomiting, and insomnia, with a relatively low risk of sexual side effects and weight gain 3, 4, 5, 6.
- The number needed to treat (NNT) for response and remission with vilazodone is 8 and 14, respectively, while the number needed to harm (NNH) for discontinuation due to adverse events is 27 6.