What is the use of Trazodone (Triazolopyridine antidepressant)?

From the Guidelines

Trazodone should not be used as a treatment for sleep onset or sleep maintenance insomnia in adults, due to its adverse effect profile and lack of efficacy compared to other treatments. This recommendation is based on the most recent and highest quality study, which advised against the use of trazodone for chronic insomnia disorder 1. The study found that trazodone was not more effective than placebo in improving sleep efficiency or reducing the rate of discontinuation due to adverse events, and its use was associated with a higher risk of adverse effects.

Key Points

• Trazodone is not recommended for the treatment of chronic insomnia disorder due to its adverse effect profile and lack of efficacy 1.
• The American Academy of Sleep Medicine also suggests that clinicians not use trazodone as a treatment for sleep onset or sleep maintenance insomnia in adults, based on trials of 50 mg doses of trazodone 1.
• Other treatments, such as eszopiclone, zaleplon, and zolpidem, are recommended for the treatment of sleep onset and sleep maintenance insomnia in adults 1.

Considerations

• Patients with chronic insomnia disorder should be counseled on the potential risks and benefits of treatment with trazodone, and alternative treatments should be considered 1.
• The use of trazodone for depression and anxiety should be carefully evaluated, and patients should be monitored for adverse effects and withdrawal symptoms when discontinuing the medication.

From the FDA Drug Label

Trazodone Hydrochloride Tablets are indicated for the treatment of major depressive disorder (MDD) in adults. The primary use of Trazodone is for the treatment of major depressive disorder (MDD) in adults.

• Key points about Trazodone include:
  • It is a prescription medicine used to treat MDD in adults
  • It belongs to a class of medicines known as SSRIs (or selective serotonin reuptake inhibitors)
  • It is not known if Trazodone Hydrochloride Tablets are safe and effective in children 2 2
  • 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 2

From the Research

Trazodone Overview

• Trazodone is a triazolopyridine serotonin receptor antagonist and reuptake inhibitor (SARI) antidepressant approved for major depressive disorder (MDD) in adults 3, 4.
• It has established efficacy comparable to other available antidepressants and is effective for a range of depression symptoms, including insomnia 3, 4.

Mechanism of Action and Efficacy

• Trazodone's pharmacodynamic properties allow it to avoid the side effects of insomnia, anxiety, and sexual dysfunction often associated with selective serotonin reuptake inhibitor antidepressants 3, 4.
• It is effective in controlling a wide range of symptoms of depression, including insomnia, and has a rapid onset of action 3, 4, 5.
• Trazodone has been shown to have antidepressant activity at a starting dose of 150 mg/day and results in statistically significant greater reduction in Hamilton Depression Rating Scale (HAM-D17) scores within 1 week of starting treatment compared to placebo or venlafaxine XR 5.

Side Effects and Tolerability

• The most common adverse effects of trazodone are somnolence, headache, dizziness, and xerostomia 3, 4, 6.
• Trazodone has minimal anticholinergic activity but may be associated infrequently with orthostatic hypotension, QT interval prolongation, cardiac arrhythmias, and rare episodes of priapism 3, 4.
• It has a low risk of anticholinergic side effects, weight gain, and sexual side effects, making it a well-tolerated antidepressant 7.

Clinical Guidance and Use

• Trazodone is usually well tolerated and has a low risk of side effects, making it an established medication for the treatment of a broad array of depressive symptoms 7.
• It may be helpful for patients with major depression and comorbid insomnia, anxiety, or psychomotor agitation 7.
• The appropriate antidepressant doses are usually 150-300 mg/day, and trazodone is often used to augment the antidepressant effect of another medication, such as addressing insomnia in a patient treated with an SSRI 7.