What is the use of trazodone (antidepressant)?

From the Guidelines

Trazodone is recommended as a viable treatment option for depression and insomnia, with a typical starting dose of 150mg daily for depression and 25-100mg at bedtime for insomnia, due to its ability to increase serotonin levels and block certain serotonin and histamine receptors, as supported by studies such as 1.

Key Points to Consider

• Trazodone's dual action of increasing serotonin levels and blocking certain receptors makes it useful for patients with depression and sleep difficulties.
• Common side effects include drowsiness, dizziness, dry mouth, and occasionally priapism, which requires immediate medical attention.
• The medication should be taken with food to reduce stomach upset, and patients should avoid alcohol as it can increase drowsiness.
• It's crucial to continue taking trazodone as prescribed and not stop abruptly to avoid withdrawal symptoms.
• Full antidepressant effects may take 2-4 weeks to develop, though sleep improvements often occur more quickly, as noted in guidelines such as 1 and 1.

Important Considerations for Treatment

• The choice of trazodone may be influenced by factors such as treatment history, coexisting conditions, specific side effect profile, cost, and pharmacokinetic profile.
• For patients with comorbid depression and insomnia, trazodone can be considered as part of a comprehensive treatment plan, but it is essential to ensure that the dose is adequate for treating depression, as low-dose sedating antidepressants do not constitute adequate treatment for major depression.
• Regular assessment of patient status, therapeutic response, and adverse effects of antidepressant therapy is recommended, beginning within 1 to 2 weeks of initiation of therapy, as emphasized in 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).

Trazodone is used to treat major depressive disorder (MDD) in adults.

• The primary use of trazodone is for the treatment of MDD.
• It is not known if trazodone is safe and effective in children 2.
• Trazodone belongs to a class of medicines known as antidepressants.
• Key warnings include the risk of suicidal thoughts or actions, especially in children, teenagers, and young adults within the first few months of treatment 2.

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, including insomnia, which is one of the most common and bothersome symptoms of depression 4, 5, 6.

Adverse Effects and Tolerability

• 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.
• Trazodone is usually well-tolerated and has a low risk of anticholinergic side effects, weight gain, and sexual side effects 5.

Formulations and Dosage

• 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.
• The appropriate antidepressant doses of trazodone are usually 150-300 mg/day and are often higher than the doses used when trazodone is prescribed to augment the antidepressant effect of another medication 5.
• Trazodone once-a-day extended-release (XR) has been shown to be effective in improving the health status and quality of life of patients with major depressive disorder, with greater improvements compared to SSRIs in some measures 7.

Clinical Use and Recommendations

• Trazodone may be helpful for patients with major depression and comorbid insomnia, anxiety, or psychomotor agitation 4, 5.
• Trazodone is an established medication that is 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) 5.
• Early response to trazodone once-a-day in major depressive disorder has been observed, with significant improvements in depressive symptoms and sleep disturbance within 1 week of starting treatment 6.