From the Guidelines
Trazodone is recommended as a treatment option for depression and insomnia, with a typical starting dose of 150mg daily for depression and 25-100mg taken before bedtime for insomnia, due to its efficacy and safety profile as supported by the American College of Physicians guideline 1.
Key Points
- Trazodone works by increasing serotonin levels in the brain while also blocking certain serotonin receptors and histamine receptors, which contributes to its sedative effects.
- Common side effects include drowsiness, dizziness, dry mouth, and blurred vision.
- More serious but rare side effects include priapism (prolonged erection) in men, which requires immediate medical attention.
- Trazodone should be taken with food to reduce stomach upset, and patients should avoid alcohol while using this medication as it can increase drowsiness.
- The American College of Physicians recommends that clinicians choose pharmacologic therapy to treat patients with acute major depression, selecting second-generation antidepressants on the basis of adverse effect profiles, cost, and patient preferences 1.
Treatment Considerations
- The dosage of trazodone should be gradually increased as needed and under medical supervision.
- Patients should not stop taking trazodone suddenly, as this can cause withdrawal symptoms; dosage should be gradually reduced under medical supervision.
- Trazodone's sedative properties make it a common off-label choice for treating insomnia, particularly in patients who also have depression or anxiety, as noted in the clinical guideline for the evaluation and management of chronic insomnia in adults 1.
From the FDA Drug Label
Trazodone Hydrochloride Tablets are indicated for the treatment of major depressive disorder (MDD) in adults. Trazodone Hydrochloride Tablets are a prescription medicine used in adults to treat major depressive disorder (MDD).
The primary use of trazodone is for the treatment of major depressive disorder (MDD) in adults.
- Key points:
From the Research
Trazodone Overview
- Trazodone is a triazolopyridine derivative that belongs to the class of serotonin receptor antagonists and reuptake inhibitors (SARIs) 3, 4, 5.
- It is approved and marketed in several countries worldwide for the treatment of major depressive disorder (MDD) in adult patients 3.
Efficacy and Mechanism of Action
- Trazodone has demonstrated comparable antidepressant activity to other drug classes, including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin-noradrenaline (norepinephrine) reuptake inhibitors (SNRIs) 3, 4, 5.
- The SARI action of trazodone may overcome the tolerability issues that are often associated with second-generation antidepressants such as SSRIs (i.e., insomnia, anxiety, and sexual dysfunction) 3, 4, 5.
- Trazodone is effective in controlling a wide range of symptoms of depression, while avoiding the negative effects on sleep seen with SSRI antidepressants 3, 4, 5.
Adverse Effects and Safety
- The most common adverse effects reported with trazodone are drowsiness (somnolence/sedation), headache, dizziness, and dry mouth 3, 4, 5.
- Other events reported, albeit with low incidence, include orthostatic hypotension, minimal anticholinergic activity, corrected QT interval prolongation, and torsade de pointes, cardiac arrhythmias, and rare occurrences of priapism and suicidal ideation 3, 4, 5, 6.
- Trazodone overdose can manifest as hypotension and QT prolongation, and requires close monitoring to prevent complications 6.
Dosage and Formulation
- The appropriate antidepressant doses of trazodone are usually 150-300 mg/day 4, 5.
- A new prolonged-release once-a-day formulation of trazodone (TzCOAD) has been developed, which may provide improved tolerability over the conventional immediate-release formulation of trazodone 3, 4.
- The once-a-day formulation of trazodone has an improved tolerability profile compared to its conventional formulations, and exhibits antidepressant activity at a starting dose of 150 mg/day 7.