From the Guidelines
Vilazodone is generally preferred over trazodone for treating depression due to its more favorable side effect profile and efficacy as a selective serotonin reuptake inhibitor (SSRI) and partial serotonin receptor agonist. When considering the treatment of depression, it's essential to evaluate the efficacy and safety of various antidepressant medications. Vilazodone and trazodone are two such medications, but they have distinct properties and uses. Vilazodone, a newer antidepressant, works as both an SSRI and a partial serotonin receptor agonist, typically prescribed at doses of 20-40mg once daily for major depressive disorder 1. On the other hand, trazodone is an older medication that primarily works as a serotonin antagonist and reuptake inhibitor (SARI), commonly prescribed at 50-150mg for insomnia and 150-400mg for depression.
Some key differences between vilazodone and trazodone include their sedating effects, with vilazodone having less sedating effects compared to trazodone. Additionally, vilazodone tends to cause less sexual dysfunction and weight gain than traditional SSRIs, but may cause more gastrointestinal side effects initially 1. Trazodone, being a generic medication with a longer history of use, is generally less expensive but can cause significant morning grogginess when used as a sleep aid.
In terms of efficacy, research has shown that trazodone can improve sleep scores compared to fluoxetine and venlafaxine 1. However, when treating depression in patients with accompanying symptom clusters, second-generation antidepressants, including vilazodone and trazodone, did not differ significantly in efficacy in treating accompanying anxiety, insomnia, and pain 1.
The choice between vilazodone and trazodone ultimately depends on the primary goal of treatment, whether it's addressing depression, sleep issues, or both. Given the more favorable side effect profile and efficacy of vilazodone, it is generally preferred for treating depression. However, trazodone may still be a suitable option for patients with depression and sleep issues, particularly when cost is a consideration.
Some key points to consider when choosing between vilazodone and trazodone include:
- Efficacy in treating depression and accompanying symptom clusters
- Side effect profiles, including sedating effects, sexual dysfunction, and weight gain
- Cost and availability of the medication
- Patient-specific factors, such as age, sex, and comorbid conditions
By carefully evaluating these factors and considering the latest evidence, healthcare providers can make informed decisions when choosing between vilazodone and trazodone for the treatment of depression.
From the FDA Drug Label
The mechanism of trazodone’s antidepressant action is not fully understood, but is thought to be related to its enhancement of serotonergic activity in the CNS Trazodone is both a selective serotonin reuptake inhibitor (SSRI) and a 5HT2 receptor antagonist Vilazodone hydrochloride was superior to placebo in the improvement of depressive symptoms as measured by the change from baseline to endpoint visit in the Montgomery-Asberg Depression Rating Scale (MADRS) total score for both doses
Comparison of Vilazodone and Trazodone:
- Both vilazodone and trazodone are used to treat major depressive disorder (MDD)
- Mechanism of Action: Trazodone's mechanism is not fully understood, but it is thought to be related to its enhancement of serotonergic activity in the CNS, while vilazodone's mechanism is not directly stated in the provided text
- Efficacy: Vilazodone was shown to be superior to placebo in improving depressive symptoms, while trazodone's efficacy is not directly compared to vilazodone in the provided text 2, 3
- Pharmacokinetics: Trazodone is extensively metabolized by CYP3A4, while vilazodone is also extensively metabolized through CYP and non-CYP pathways, with CYP3A4 being primarily responsible for its metabolism
- Key Differences:
- Trazodone has a more complex pharmacological profile, with activity at multiple serotonin receptors, while vilazodone's profile is not as clearly defined in the provided text
- Vilazodone has been shown to be effective in clinical trials, while trazodone's efficacy is not directly compared to vilazodone in the provided text 2, 3
From the Research
Comparison of Vilazodone and Trazodone
- Vilazodone is a dual-acting serotonergic agent that combines the antidepressant effects of a selective serotonin-reuptake inhibitor (SSRI) with partial serotonin (5-HT)(1A)-receptor agonist activity 4.
- Trazodone is an antidepressant with a mechanism of action that remains innovative and has a favorable profile for the treatment of depression 5.
Efficacy
- Vilazodone has been shown to be efficacious in the treatment of major depressive disorder (MDD) in adults, with significant symptomatic improvements relative to placebo 4, 6, 7.
- Trazodone is also efficacious for the treatment of a broad array of depressive symptoms, including symptoms that are less likely to respond to other antidepressants (e.g. SSRI), such as insomnia 5.
Safety and Tolerability
- Vilazodone is generally well tolerated, with the most common treatment-emergent adverse events being mild or moderate diarrhea, nausea, and headache 4, 6, 7.
- Trazodone is usually well tolerated and has a low risk of anticholinergic side effects, weight gain, and sexual side effects 5.