Major Depressive Disorder
Trazodone is used in the treatment of major depressive disorder. The drug is used in patients who exhibit a prominent and relatively persistent (nearly every day for at least 2 weeks) depressed or dysphoric mood that usually interferes with daily functioning and is manifested as a change in appetite, psychomotor agitation or retardation, a loss of interest in usual activities, a decrease in sexual drive, increased fatigability, a change in sleep, feelings of guilt or worthlessness, slowed thinking or impaired concentration, and/or suicidal ideation or attempts. Trazodone has been used effectively in the treatment of patients who have major depression with or without prominent anxiety. In addition, trazodone has been used effectively in patients with major depression in hospital, institutional, and outpatient settings. Unlike tricyclic antidepressants, trazodone generally has not been reported to precipitate hypomanic or manic attacks in patients with bipolar disorder; however, further study is needed to determine the safety and efficacy of trazodone when used alone as an antidepressant in these patients.
Trazodone is particularly effective in reducing affective and ideational manifestations of depression, especially anxiety, apathy, irritability, and suicidal thoughts. Somatic signs and symptoms associated with depression, including sleep disturbances and fatigue, are also reduced during trazodone therapy. Most clinical studies have shown that the antidepressant effect of usual dosages of trazodone in patients with moderate to severe depression is about equal to that of usual dosages of amitriptyline, imipramine, or doxepin. However, trazodone has reportedly caused fewer adverse effects (e.g., anticholinergic effects) than these tricyclic antidepressants.
(See Cautions: Anticholinergic Effects.)Although trazodone has been reported to have a slightly more rapid onset of action than amitriptyline, desipramine, or imipramine, this has not been established.
Trazodone has been used in patients with major depression who have associated anxiety. Based on limited data, the antidepressant effect of usual dosages of trazodone appears to be greater than that of amitriptyline or imipramine in these patients. Trazodone is particularly effective in reducing anxiety, tension, somatic symptoms, insomnia, and psychomotor retardation in these patients.
For further information on treatment of major depressive disorder and considerations in choosing the most appropriate antidepressant for a particular patient, including considerations related to patient tolerance, patient age, and cardiovascular, sedative, and suicidal risk, .
Although trazodone has been used in the treatment of schizophrenic disorder, the drug is less effective than chlorpromazine. Depressive symptomatology may improve during trazodone therapy, but the drug does not appear to relieve psychotic symptoms in most schizophrenic patients. Based on limited data, trazodone has little value when used alone in patients with chronic schizophrenic disorder without depression; however, it may be a useful adjunct to antipsychotic agents (e.g., phenothiazines) in patients with chronic schizophrenic disorder and associated depression. Unlike tricyclic antidepressants, trazodone does not appear to worsen psychotic symptoms in these patients.
Trazodone has been used in the adjunctive treatment of alcohol dependence. In a limited number of patients with alcohol dependence, oral (50-75 mg daily) or IV (50 mg twice daily) trazodone has reduced tremor, depression, and anxiety. In one study, trazodone was more effective in patients who had pronounced affective symptomatology during periods of intoxication and abstention than in those who only had affective symptomatology during intoxication. Further study is needed to determine the efficacy of trazodone in the treatment of alcohol dependence.
Trazodone has been used in a limited number of patients for the treatment of erectile dysfunction (ED, impotence); however, the American Urological Association (AUA) states that such therapy currently is not recommended. Although some studies indicated that trazodone was more effective than placebo for the treatment of erectile dysfunction, other comparative studies did not. In addition, pooled analysis of these studies failed to show a statistically beneficial effect of the drug on sexual function, although subgroup analysis suggested possible benefit in those with psychogenic erectile dysfunction.
Trazodone may be useful in the treatment of some patients with anxiety states (anxiety neuroses). In one study, the drug reduced anxiety, tension, somatic symptoms, and insomnia in most of these patients. Based on limited data, trazodone appears to have a greater anxiolytic effect than some other antidepressant agents (e.g., tricyclic antidepressants); however, further study is needed to confirm this finding.
Trazodone has been used in the symptomatic treatment of a limited number of patients with drug-induced dyskinesias. In one placebo-controlled study in patients with levodopa-induced dyskinesias, oral trazodone (60-120 mg daily) reduced signs and symptoms of dyskinesia by up to 50%. In this study, most patients showed some improvement, with greatest improvement in facial, oro-buccal-facial, and neck dyskinesias. In another study, IV trazodone (50 mg twice daily) eliminated chronic chlorpromazine- and haloperidol-induced tardive dyskinesias in some patients. The decrease in tremor was accompanied by a reduction in anxiety, which may be partly responsible for the favorable effect of trazodone on tremor in these patients. Additional studies are required to determine the efficacy of trazodone in the treatment of drug-induced dyskinesias.