What is the use of trazodone (antidepressant)?

From the Guidelines

Trazodone should be used with caution, considering its potential risks and benefits, and only when other treatments have failed, due to the lack of strong evidence supporting its efficacy and safety, particularly in older adults 1.

Overview of Trazodone

Trazodone is an antidepressant medication that belongs to the serotonin antagonist and reuptake inhibitor (SARI) class. It is primarily used to treat depression and insomnia. For depression, typical dosing starts at 150mg daily, often divided into multiple doses, and may be gradually increased to 300-400mg daily if needed. For insomnia, a lower dose of 25-100mg at bedtime is commonly prescribed.

Mechanism of Action and Side Effects

Trazodone works by increasing serotonin levels in the brain while also blocking certain serotonin receptors, which helps regulate mood and sleep patterns. Common side effects include drowsiness, dizziness, dry mouth, and blurred vision. More serious but rare side effects include priapism (prolonged erection) in men, which requires immediate medical attention.

Clinical Considerations

• Trazodone should be taken as prescribed, and patients should avoid abrupt discontinuation as this may cause withdrawal symptoms.
• It may take 2-4 weeks to experience the full antidepressant effects, though sleep improvements often occur sooner.
• Patients should avoid alcohol while taking trazodone as it can increase drowsiness and dizziness.
• The use of trazodone, especially in older adults, is associated with significant risks, including priapism, orthostatic hypotension, and cardiac arrhythmias, and there is virtually no evidence-based data to support its efficacy in this population 1.

Recommendations

• Trazodone should be considered a second-line treatment option for insomnia and depression, due to its potential risks and the availability of other treatments with stronger evidence supporting their efficacy and safety.
• Clinicians should carefully weigh the potential benefits and risks of trazodone and consider alternative treatments, especially in older adults or patients with a history of certain medical conditions.
• Patients should be closely monitored for adverse effects and withdrawal symptoms when taking trazodone, and the medication should be tapered off gradually when discontinuing use.

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).

The primary use of trazodone is for the treatment of major depressive disorder (MDD) in adults.

• Key points:
  • Trazodone is used to treat MDD in adults.
  • It belongs to a class of medicines known as antidepressants.
  • The medication should be taken exactly as prescribed by a healthcare provider.
  • It is not known if trazodone is safe and effective in children. 2 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, and has a rapid onset of action 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 has a low risk of anticholinergic side effects, weight gain, and sexual side effects 5.

Comparison with Other Antidepressants

• Trazodone has been compared to SSRIs in terms of its impact on health status and quality of life in patients with MDD, with trazodone showing greater improvements in certain measures 7.
• 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 MDD, with preferable scores compared to SSRIs 7.