Rethinking the role of trazodone in the different depressive dimensions

ABSTRACT

Introduction

The efficacy of trazodone for several psychopathologic dimensions of depression has been shown in the literature. Trazodone has been widely used in some clinical contexts (e.g. for insomnia and depression in the elderly). However, the role of trazodone in several aspects of depression is not well known.

Area covered

Eight experts from academic and medical centers across Italy met to identify the difficulties and barriers faced in daily clinical practice in the assessment and management of major depressive disorder and how the use of trazodone could address some unmet needs. The objective of the expert meetings and the present document was to increase knowledge of particular areas of treatment with trazodone.

Expert opinion

Evidence of the role of trazodone in patients affected by major depressive disorder with anxiety symptoms, insomnia, agitation, cognitive deficits, alcohol use disorders, physical comorbidities, and suicide risk has been identified, showing the effectiveness of trazodone in different presentations of major depressive disorder. The main characteristics of patients with depression for whom trazodone seems to be most effective have been identified, providing clinicians with information on possible uses of this drug in such population of patients.

KEYWORDS:

• Alcohol use disorders
• anxiety
• cognitive deficit
• major depressive disorder
• suicide risk
• trazodone

Article highlights

• The management of major depressive disorder needs a comprehensive assessment and proper establishment of the depressive manifestations of each patient to choose the most suitable antidepressant for each specific condition.

• Trazodone may be more effective in individuals experiencing depression associated with anxiety, agitation, insomnia, cognitive symptoms, and co-occurring conditions.

• Trazodone displays a good safety and tolerability profile in terms of reduced risks of falls, tolerance, physical dependence, and cognitive impairment.

• Trazodone is a valid therapeutic option and is available in different formulations, including an immediate-release formulation (available as tablets or liquid drops), a prolonged-release formulation, and an extended-release formulation. Trazodone is also available as an injectable formulation that can be used for managing acute clinical conditions characterized by agitation.

• Trazodone may be a valid option for reducing the risk of suicide in cases of major depressive disorder, given its efficacy as an antidepressant in reducing anxiety, agitation, and insomnia. Therefore, it is reasonable to suggest that trazodone is an antidepressant agent that can improve sleep and provide relief for irritability and anxiety in clinical practice.

Declaration of interest

M Pompili wishes to disclose that in the last five years, he has received lectures and advisory board honoraria or has engaged in clinical trial activities with Angelini Pharma, Allergan, Janssen, Lundbeck, Merck Sharp and Dohme, Otsuka, Rovi, Pfizer Inc, Fidia, Viatris, Recordati, Boehringer Ingelheim and Teva, all of which are unrelated to this article. G Deste wishes to disclose that he has received honoraria lectures from Italfarmaco in the last five years, which are unrelated to this article. F Bartoli has received, in the last five years consultant fees from IQVIA Solutions Italy, Edra Spa, CTP Srl, Prex Srl, and honoraria for editorial activities from Elsevier, IMR Press, Med Reviews Ltd. L Orsolini disclosed that in the last five years, she has received consultant fees and/or lectures or has engaged in clinical trial activities with Angelini Pharma, Janssen, Lundbeck, Otsuka, Rovi, all of which are unrelated to this article. She has received honoraria for editorial activities from Springer, Frontiers and MDPI. A. Cuomo disclosed that in the last five years, he has received consultant fees and/or lectures or has engaged in clinical trial activities with leading companies in the psychopharmacological field, A. Cuomo disclosed that in the last five years, he has received consultant fees and/or lectures or has engaged in clinical trial activities with leading companies in the psychopharmacological field: Angelini Pharma, Merck, Janssen, Lundbeck, Otsuka, Rovi, Pfizer, Eli Lilly, Roche, Novartis, GlaxoSmithKline (GSK), AstraZeneca, Bristol-Myers Squibb, Teva Pharmaceuticals, Amgen, Sanofi, Boehringer Ingelheim, AbbVie, Takeda, and Biogen, all of which are unrelated to this article. A Amerio declares that in the last five years, he has received consultant fees and/or lectures or has engaged in clinical trial activities with Angelini Pharma, all unrelated to this article. I Berardelli disclosed that in the last five years, she has received consultant fees and/or lectures or has engaged in clinical trial activities with Angelini Pharma, Janssen Pharmaceuticals, Lundbeck, Rovi, all unrelated to this article. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

One reviewer has received research grant and advisory board funding from Angelini Pharma. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This article was supported by unrestricted sponsorship from Angelini Pharma.