What is the recommended treatment regimen for major depressive disorder using trazodone (antidepressant)?

From the Guidelines

Trazodone is typically prescribed for major depressive disorder at an initial dose of 150 mg per day, divided into two or three doses with food. The dose can be gradually increased by 50 mg every 3-4 days as needed and tolerated, up to a maximum of 400 mg daily for outpatients or 600 mg for inpatients. Most patients respond to doses between 150-300 mg daily. Treatment should continue for at least 6-8 weeks to properly assess efficacy, and if effective, treatment should be maintained for at least 6-12 months to prevent relapse. Trazodone should be taken consistently, preferably with food to reduce side effects, and the largest portion of a divided dose is typically given at bedtime to help with sleep disturbances. Patients should be aware that common side effects include sedation, dizziness, dry mouth, and priapism in males (which requires immediate medical attention). Trazodone works primarily by inhibiting serotonin reuptake and blocking certain serotonin receptors, with its sedative properties making it particularly useful for patients with depression accompanied by insomnia. Abrupt discontinuation should be avoided; the medication should be tapered gradually under medical supervision to prevent withdrawal symptoms.

Some key points to consider when prescribing trazodone include:

• The American College of Physicians recommends selecting second-generation antidepressants, including trazodone, on the basis of adverse effect profiles, cost, and patient preferences 1.
• Clinicians should assess patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis beginning within 1 to 2 weeks of initiation of therapy 1.
• Treatment should be modified if the patient does not have an adequate response to pharmacotherapy within 6 to 8 weeks of the initiation of therapy for major depressive disorder 1.
• Clinicians should continue treatment for 4 to 9 months after a satisfactory response in patients with a first episode of major depressive disorder, and for patients who have had 2 or more episodes of depression, an even longer duration of therapy may be beneficial 1.

It's also important to note that trazodone can be used in combination with other therapies, such as psychotherapy or cognitive behavioral therapy, to manage depression. The goal of treatment is to achieve remission and prevent relapse, and clinicians should work with patients to develop a treatment plan that takes into account their individual needs and preferences. Overall, trazodone can be an effective treatment option for major depressive disorder, but it's essential to carefully monitor patients and adjust treatment as needed to minimize side effects and maximize efficacy.

From the FDA Drug Label

Trazodone Hydrochloride Tablets are indicated for the treatment of major depressive disorder (MDD) in adults. Take Trazodone Hydrochloride Tablets exactly as your healthcare provider tells you Trazodone Hydrochloride Tablets should be taken shortly after a meal or light snack.

The recommended treatment regimen for major depressive disorder using trazodone is to take the medication exactly as prescribed by a healthcare provider, shortly after a meal or light snack. Key points to consider include:

• Taking the medication as directed
• Swallowing the tablets whole or breaking them in half along the score line
• Not chewing or crushing the tablets
• Informing the healthcare provider if you cannot swallow the tablets
• Following up with the healthcare provider to monitor treatment and adjust the dose as needed 2, 2.

From the Research

Trazodone Treatment Regimen for Major Depressive Disorder

• Trazodone is a triazolopyridine derivative that belongs to the class of serotonin receptor antagonists and reuptake inhibitors (SARIs) 3, 4.
• The recommended dosage of trazodone for major depressive disorder (MDD) is 150-300 mg/day, with a once-daily formulation available that provides improved tolerability over the conventional immediate-release formulation 3, 4.
• 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.
• The most common adverse effects reported with trazodone are drowsiness (somnolence/sedation), headache, dizziness, and dry mouth, with minimal anticholinergic activity and a low incidence of weight gain and sexual dysfunction 3, 4.

Dosage and Administration

• Trazodone can be administered as a single daily dose, with a dose weighted at bedtime, to improve sleep and reduce daytime drowsiness 5.
• The initial dose of trazodone is typically 150 mg, given predominantly at bedtime, and can be increased as needed to 200-300 mg for full antidepressant efficacy 5.
• Geriatric patients respond similarly to trazodone, with a maximum tolerated dose of 300-400 mg/day 6.

Efficacy and Safety

• Trazodone has established efficacy in controlling a wide range of symptoms of depression, including insomnia, and is effective for a range of depression symptoms 3, 4.
• Trazodone is relatively safe in overdose, with a mild side effect profile, and is well-tolerated in elderly patients, with a low incidence of anticholinergic and cardiovascular effects 3, 6.
• However, trazodone may be associated with orthostatic hypotension, QT interval prolongation, cardiac arrhythmias, and rare episodes of priapism, which require close monitoring 3, 4.