From the Guidelines
Trazodone should not be used for the treatment of behavioral and psychological symptoms of dementia (BPSD) due to lack of evidence and potential risks. The WHO recommendations [ 1 ] clearly state that trazodone, along with thioridazine and chlorpromazine, should not be used for BPSD treatment. Instead, other management options should be considered, such as non-pharmacological interventions, cognitive stimulation, and reality orientation [ 1 ].
When considering treatment for BPSD, it's essential to prioritize non-pharmacological approaches, including cognitive interventions and psychosocial interventions [ 1 ]. If medication is necessary, selective serotonin reuptake inhibitors (SSRIs) may be considered for moderate or severe depression in people with dementia [ 1 ]. However, trazodone is not recommended due to the lack of evidence supporting its use for BPSD.
Key considerations for managing BPSD include:
- Non-pharmacological interventions as the first line of treatment
- Cognitive stimulation and reality orientation
- Psychosocial interventions
- Selective use of medications, such as SSRIs, for specific indications like depression
- Regular medical review and monitoring for people with dementia [ 1 ]
In summary, the current evidence does not support the use of trazodone for BPSD, and alternative management strategies should be prioritized to ensure the best possible outcomes for patients with dementia.
From the Research
Evidence for Trazodone in BPSD
- Trazodone, an atypical antidepressant, has been used for the treatment of Behavioral and Psychological Symptoms of Dementia (BPSD) [(2,3,4)].
- A retrospective study found that trazodone improved BPSD in 9 out of 13 Alzheimer's disease patients, with significant improvement in aggression and negativism in caregiving situations 2.
- A double-blind comparison of trazodone and haloperidol found that both medications were equally effective in treating agitated behaviors in patients with dementia, but trazodone was associated with fewer adverse effects 3.
- Another study found that trazodone was more effective in improving behavioral symptoms in patients with dementia who had mild depressive symptoms, whereas haloperidol was not associated with greater behavioral improvement in patients with delusions 4.
Comparison with Other Medications
- Risperidone, an atypical antipsychotic, has been widely used to treat BPSD, including agitation, aggression, and psychosis, and has been found to be effective in several studies [(5,6)].
- A comparative study found that risperidone was more effective than haloperidol in treating specific manifestations of BPSD, including wandering, agitation, and anxieties 6.
- However, trazodone has not been directly compared to risperidone in the treatment of BPSD, and more studies are needed to determine its efficacy and safety in this population [(2,3,4)].