Trazodone for Depression Treatment
Trazodone is FDA-approved and indicated for the treatment of major depressive disorder (MDD) in adults. 1
Efficacy for Depression
- Trazodone has demonstrated efficacy for treating major depressive disorder in both inpatient and outpatient settings 1
- The efficacy of trazodone has been repeatedly shown to be comparable to other antidepressant classes, including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs) 2
- Trazodone is effective for treating a broad array of depressive symptoms 3
Dosing for Depression
- For depression treatment, trazodone is typically dosed at 150-300 mg/day 4
- Trazodone should be taken shortly after a meal or light snack to minimize side effects 1
- Lower starting doses with gradual titration are recommended, especially in elderly or debilitated patients 1
Advantages for Depression with Insomnia
- Trazodone is particularly beneficial for patients with depression accompanied by insomnia 3, 4
- Studies have shown improvement in sleep scores with trazodone compared to other antidepressants like fluoxetine and venlafaxine 5
- Trazodone's pharmacodynamic properties help avoid insomnia, anxiety, and sexual dysfunction often associated with SSRIs 4
Formulations
- Conventional immediate-release formulation is available 2
- A prolonged-release once-a-day formulation (TzCOAD) has been developed to potentially improve tolerability and compliance 2, 4
Common Side Effects
- Most common adverse effects include drowsiness (somnolence/sedation), headache, dizziness, and dry mouth 1, 4
- Side effects are dose-dependent, with drowsiness being the most common 6
- Other potential adverse effects include orthostatic hypotension (particularly in elderly patients or those with heart disease), minimal anticholinergic activity, QT interval prolongation, cardiac arrhythmias, and rare occurrences of priapism 2, 4
Important Precautions
- Monitor for suicidal thoughts or actions, especially in children, teenagers, and young adults within the first few months of treatment 1
- Do not take trazodone with monoamine oxidase inhibitors (MAOIs) or within 2 weeks of stopping an MAOI 1
- Use caution in patients with heart problems, bipolar disorder, or liver/kidney problems 1
- Trazodone can interact with other medications including triptans, other antidepressants, tramadol, NSAIDs, and warfarin 1
Off-Label Uses
- While trazodone is approved for depression, it is frequently prescribed off-label at lower doses for insomnia 6, 7
- Other off-label uses include anxiety disorders, PTSD, OCD, and pain conditions, though large randomized controlled trials are needed to establish strong evidence for these indications 7
Clinical Decision Making
- For patients with depression and insomnia, trazodone may be particularly beneficial as a first-line option 3, 4
- For patients with depression who experience insomnia as a side effect of other antidepressants, low-dose trazodone can be used as an adjunct 8
- When considering combination therapy, trazodone can be safely combined with SSRIs like sertraline to address both depression and insomnia symptoms 8