Trazodone slightly improves subjective sleep quality ( SMD = –0.34 to –0.41) and reduces number of nighttime awakenings ( MD = –0.31, SMD = –0.51). Systematic reviews and meta-analyses published in the late 2010s, including a Cochrane review, found low-dose trazodone to be an effective medication for short-term treatment of insomnia both in depressed and non-depressed people. Trazodone was the second-most prescribed agent for insomnia in the early 2000s, though most studies of trazodone for treatment of sleep disturbances have been in depressed individuals. It may also be used to treat antidepressant-related insomnia. Low-dose trazodone is used off-label in the treatment of insomnia and is considered to be effective and safe for this indication. Trazodone is often used as an alternative to benzodiazepines in the treatment of anxiety disorders. Besides anxiety, trazodone has been used to treat sleep disturbances and nightmares in PTSD. However, use of trazodone in anxiety disorders is off-label and evidence of its effectiveness for these indications is variable and limited. Trazodone is often used in the treatment of anxiety disorders such as generalized anxiety disorder, panic disorder, post-traumatic stress disorder (PTSD), and obsessive–compulsive disorder (OCD). Trazodone is usually administered multiple times per day, but once-daily administration may be similarly effective. Higher doses up to 600 mg/day have been used in more severe cases of depression, for instance in hospitalized patients. Lower doses have also been used to augment other antidepressants, or when initiating therapy. Trazodone is usually used at a dosage of 150 to 300 mg/day for the treatment of depression. Still, trazodone is often helpful for geriatric patients with depression who have severe agitation and insomnia. However, a side effect of trazodone, orthostatic hypotension, which may cause dizziness and increase the risk of falling, can have devastating consequences for elderly patients thus, this side effect, along with sedation, often makes trazodone less acceptable for this population, compared with newer compounds that share its lack of anticholinergic activity but not the rest of its side-effect profile. Three double-blind studies reported trazodone has antidepressant efficacy similar to that of other antidepressants in geriatric patients. īecause trazodone has minimal anticholinergic activity, it was especially welcomed as a treatment for geriatric patients with depression when it first became available. Also, trazodone showed anxiolytic properties, low cardiotoxicity, and relatively mild side effects. Data from open and double-blind trials suggest the antidepressant efficacy of trazodone is comparable to that of amitriptyline, doxepin, and mianserin. The primary use of trazodone is the treatment of unipolar major depression with or without anxiety.
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