Trazodone is a medication used in the treatment of depression. It is classified under the piperazine group of atypical anti-depressant drugs and was the first drug of the class to be discovered. Trazodone, unlike other mainstream anti-depressants, has the action of inhibiting serotonin re-uptake as well as antagonising certain effects of serotonin. There have been other atypical anti-depressants developed after Trazodone which have a better side effect profile. However, Trazodone is better tolerated than older TCAs which have more prominent anti-cholinergic side effects and adverse effects on sexual function. Trazodone also has anti-anxiety and sedative properties which may be of benefit in certain groups of patients.
How Trazodone Works: Trazodone is an atypical anti-depressant drug. It is included in the group of phenyl-piperazine compounds. Trazodone selectively blocks the re-uptake of serotonin at the neuronal synaptic end terminals, and prolongs the effect of serotonin as a neurotransmitter. However, efficacy of this action is lower than newer atypical anti-depressants. Trazodone also has an alpha-blocking and 5-HT2 receptor antagonistic properties. This may also be contributing to its anti-depressant effect by bringing about a balance in the levels and action of serotonin as a neurotransmitter in the brain. The alpha-adrenergic antagonistic property is responsible for the side effect of postural hypotension that is seen with Trazodone.
How To Take Trazodone: Trazodone is used in the treatment of major depressive disorder (MDD). Good efficacy of Trazodone has been demonstrated in patients suffering from depression including those who may have a prominent anxiety component. Trazodone can also be used in the treatment of anxiety states and disorders, more commonly as an adjunctive drug in the management of such conditions. Trazodone is supplied as oral tablets in the strengths of 150 mg and 300 mg. For the treatment of major depression, Trazodone is administered at a recommended starting dose of 150 mg/day in divided doses. The clinical response of starting treatment with Trazodone may take some time to appear. Hence it is of utmost importance that psychotherapy, behavioural modification, counselling and other supportive therapy be continued in this duration. If response is deemed inadequate, the dose can be escalated by 50 mg/day after a minimum interval of 3-4 days. However, it should be noted that the time required for the complete effect of Trazodone to be seen is almost 2 weeks. The maximum adult dose should not exceed 400 mg/day in divided doses. The maintenance dose should be a continuation of the lowest possible dose that is seen to be effective in a particular patient. After treatment of an acute episode, if symptoms are under control, dose reduction of Trazodone may also be attempted with careful monitoring. Further dose adjustments are carried out after judging the response. In the treatment of anxiety states, 150 mg/day in divided doses may be administered. However, since it is used mainly as an adjunctive medication in these conditions, a lower dose of Trazodone may suffice in most patients, who may be taking other anti-anxiety medications.
Precautions And Side Effects Of Trazodone: Use of any anti-depressant including Trazodone has the potential to cause a worsening of depressive symptoms and development of suicidal tendency or thoughts. Careful follow-up is to be maintained. Trazodone is not recommended for use in children and in those taking MAO-inhibitor drugs. It is to be used with caution in elderly patients, those with renal or hepatic impairment, epilepsy, heart disease and cardiac rhythm disorders. Common side effects of Trazodone are drowsiness, dizziness, confusion, headache, fatigue, tremor and gastrointestinal disturbances. More serious adverse effects of Trazodone are postural hypotension, priapism, oedema of feet, blurred vision, arrhythmias and hepatic dysfunction.
