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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pharmacological and biochemical data on trazodone are reviewed in order to compare this drug to imipramine and other tricyclics both from the point of view of the mechanism of action and preferential clinical indications. Trazodone tends to inhibit biochemical and pharmacological functions depending on the catecholaminergic system, whereas imipramine has a potentiating activity. However, both these drugs decrease the density of beta-receptors following repeated administrations. Trazodone and imipramine have similar effects on the serotoninergic system. The two drugs also share an antinociceptive activity. It is stressed that this activity has been of critical importance in the discovery of trazodone. In fact, the development of this drug was based on the working hypothesis that a disturbance in the perception of unpleasant experience has a role in the pathogenesis of depression. Some medical implications of the alpha-blocking activity of trazodone are discussed. Trazodone is preferable to other antidepressant treatment when depression is associated with angle-closure glucoma, cardiovascular disturbances depending on noradrenaline release, tremor, some psychotic conditions and alcoholism.
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PMID:Trazodone, a new avenue in the treatment of depression. 614 38

Trazodone and imipramine were compared in a two-center double-blind study of moderately to severely depressed outpatients. Results for 44 patients who have completed the 12-month comparison showed superior efficacy of trazodone at endpoint on all efficacy measures. Significant differences were also seen on individual Hamilton Depression Rating Scale items, with lower anxiety scores at 5 evaluation points for the trazodone group. Clinical Global Impressions ratings also favored trazodone treatment. Anticholinergic effects and tremor were significantly more frequent in imipramine-treated patients, whereas drowsiness was more frequent with trazodone. No significant changes were seen in blood pressure or ophthalmologic exams; 2 trazodone patients and 1 imipramine patient developed slight ECG changes during therapy; these may have been age-related. Continued clinical benefit has been seen in 12 patients who have received open-label trazodone for additional periods of up to 3 years. These findings show trazodone to be clearly effective in long-term treatment of moderate to severe depression; the drug may be of particular benefit when atropine side effects pose serious problems, as in the elderly and patients with cardiovascular disorders.
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PMID:Long-term therapy for depression with trazodone. 633 31

In a double-blind trial, 146 depressed patients were allocated at random to treatment with the same daily dose (100 mg to 150 mg) of trazodone administered either as divided doses twice daily or as a single dose at night. Over the trial period of 6 weeks there was a highly significant reduction in the mean Hamilton Depression Rating Scale scores in both treatment groups, with no significant differences between them. The patients completed 10 visual analogue scales concerned with their depressive symptomatology, sleep patterns and daytime sequelae. Significant improvement was recorded on all items in both groups, the only significant between-group difference being in relation to how tired the patient felt during the day, which was significantly better on night-time dosage at Weeks 1 and 2. The most significant finding of the study was in relation to the sleep questionnaires completed by the patients on awakening and again in the evening. Trazodone administered as a single dose at night or when given in twice daily divided dosage, improved sleep. During the first week this effect was significantly better for the single dose at night group. This early effect may be particularly useful in providing psychological encouragement to depressed patients at the onset of treatment.
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PMID:Trazodone: alternative dose regimens and sleep. 637 81

Depression and dysphoria can follow the long-term use of cocaine. Little is known about the interaction of antidepressant drugs with cocaine and similar stimulants in humans. The physiologic and subjective effects of an oral 2-mg/kg dose of cocaine hydrochloride were measured in eight healthy cocaine-using men after pretreatment with a single, 100-mg oral dose of the triazolopyridine antidepressant trazodone hydrochloride or placebo in a double-blind study. The cocaine-induced effects of increased BP, increased pupil size, and decreased skin temperature were diminished by trazodone pretreatment. Trazodone alone did not alter plasma epinephrine or norepinephrine levels. An increase in plasma epinephrine levels after cocaine administration was not altered by trazodone pretreatment, but the increase in the norepinephrine level was larger. Trazodone alone produced mild sleepiness. Cocaine-induced euphoria was not altered by trazodone pretreatment, although feelings of tension and shakiness after cocaine administration were diminished.
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PMID:Trazodone-oral cocaine interactions. 638 Apr 47

The clinical efficacy and tolerability of trazodone and amitriptyline were compared in 74 hospital patients suffering from depressive illness. The daily doses of trazodone and amitriptyline were 150-300 mg and 75-225 mg, respectively, with half-strength capsules for patients over the age of 65 years. Twenty-five and 29 patients receiving trazodone and amitriptyline, respectively, completed the 6 week treatment period. Antidepressant activity was measured using the Hamilton Depression Rating Scale (HDRS), the Zung Scale of Depression, visual analogue scales and a Global Assessment Scale. Trazodone and amitriptyline were both effective but not statistically different from each other in terms of antidepressant action. Moreover, patients with neurotic or endogenous depression responded equally well on either treatment. Trazodone was less troublesome in respect of the persistent dry mouth and severe adverse psychiatric reactions which occurred with amitriptyline. Patients should be advised to take trazodone after meals.
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PMID:Trazodone. A comparative clinical and predictive study. 639 36

Trazodone (TZ), a 'new generation' antidepressant and amitriptyline (AMT) were administered in a double-blind controlled study to 43 depressed inpatients. The Hamilton Depression Rating Scale (HAM-D), the AMDP-system and the Bf-s self-rating questionnaire were used for documentation of psychopathological changes and autonomic side effects. The Newcastle-Scale for definition of a neurotic and an endogenous subgroup of depression was retrospectively applied. No significant improvement was noticed on the Bf-s self-rating questionnaire in the TZ group as compared to the AMT group (p less than 0.001). The global HAM-D score decreased significantly in the TZ group (p less than 0.05) as well as in the AMT group difference (p less than 0.01) emerged during the trial in favour of AMT. Core symptoms of depression were significantly improved in the AMT group but not in the TZ group: depressed mood (p less than 0.001), psychic anxiety (p less than 0.001) and retardation (p less than 0.05). TZ was faster actin than AMT in controlling agitation. Results of this clinical study demonstrate TZ to have sedative and some anxiolytic properties but only negligible antidepressant efficacy.
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PMID:Trazodone and amitriptyline in treatment of depressed inpatients. A double-blind study. 702 79

Trazodone is the first triazolopyridine derivative to be used clinically for the treatment of depression. It has been shown to be equal in efficacy to the tricyclic antidepressants imipramine, desipramine, and amitriptyline in the treatment of major depressive episodes. Researchers have indicated that trazodone exceeds other antidepressants in relieving anxiety, but further study is needed to confirm this effect. Trazodone has been used successfully to relieve depression in schizophrenic patients without worsening their psychotic symptoms. Trazodone blocks serotonin reuptake into presynaptic neurons with little effect on norepinephrine or dopamine. It is rapidly absorbed orally and reaches peak serum levels within two hours. Trazodone is excreted primarily as metabolites by the kidneys and possesses a biphasic elimination half-life of 4.4 hours for the first 10 hours and 7.5 hours for the next 24 hours. Trazodone 200 mg is equal to imipramine 100 mg, and the therapeutic dosage range is 200-600 mg/d. Side effects are infrequent with trazodone; its anticholinergic activity is minimal. Trazodone appears to produce less cardiovascular toxicity than tricyclic antidepressants. To date, reports of fatal overdoses are rare. Trazodone equals available antidepressant drugs in clinical efficacy, and, because it has fewer cardiovascular and anticholinergic side effects, it should prove beneficial in the treatment of depression.
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PMID:Trazodone (Desyrel, Mead-Johnson Pharmaceutical Division). 703 72

Prolactin and somatotropin secretory rhythmicity was studied in 7 inhibited depression male patients, evaluated by the Hamilton Rating Scale for depression, before and after trazodone (400 mg i.v. once daily) treatment. The mean 24-hour hormone levels of the patients were comparable to the controls. Trazodone enhances the prolactin value, increasing chiefly the titres during sleep which were lower in respect to controls before treatment. The drug decreases the mean 24-hour somatotropin levels, mainly the values during sleep. A serotoninergic effect is possibly involved. An improvement of mood has been observed in all cases.
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PMID:Neuroendocrinological and clinical data upon trazodone treatment in depressed patients. 713 75

A double-blind study was conducted to determine the efficacy and safety of trazodone vs. amitriptyline and placebo in 184 patients suffering from neurotic depression. All patients were evaluated for safety and 127 patients who completed 12 to 42 days' therapy were evaluated for efficacy. Trazodone was found to be significantly better than placebo on almost every rating scale, particularly on those items or factors related to depression and associated anxiety. Trazodone was superior to amitriptyline in some patients while amitriptyline was only occasionally better than placebo. Significant improvement was noted in trazodone patients within the first seven days of therapy. Trazodone produced a low level of side effects compared to amitriptyline.
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PMID:Trazodone in the treatment of neurotic depression. 744 May 19

Major depression is a common and disabling disorder with far-reaching social and economic implications. Nonetheless, major depression is treatable by one of the many currently available antidepressants with response rates of approximately 65-70%. Treatment of depression has improved in recent years because of the availability of effective and well-tolerated antidepressants, such as the selective serotonin reuptake inhibitors (SSRIs). The currently available antidepressants are generally equally effective and are distinguished primarily by side-effect profiles. The side effects of tricyclic antidepressants (TCAs) are attributed to their nonspecific interaction with cholinergic, histaminergic, serotonergic, and dopaminergic receptors in the central nervous system. The secondary amine TCAs, nortriptyline and desipramine, are preferred among the TCAs because of a more favorable side-effect profile. The TCAs are cardiotoxic, and overdoses are frequently fatal. Adverse effects, including potentially fatal drug and food interactions, limit the use of the monoamine oxidase inhibitors (MAOIs); however, these agents have a role in the treatment of depression with comorbid anxiety, refractory depression, atypical depression, and bulimia. The SSRIs possess a class side-effect profile of headache, nausea, and sexual dysfunction. Individual differences in side effects may distinguish fluoxetine (nervousness, restlessness), sertraline (diarrhea, loose stools), and paroxetine (dry mouth). The SSRIs all inhibit certain cytochrome P450 isoenzymes involved in the metabolism of drugs, such as the TCAs, and each SSRI has been reported to increase plasma concentrations of concomitantly administered TCAs. Bupropion therapy is associated with a risk of seizure development, which can be minimized by multiple daily doses. Trazodone is sedating and can rarely cause priapism. The related compound, nefazodone, does not cause sexual dysfunction or priapism, but is associated with sedation. Venlafaxine, a recently available antidepressant that appears to have efficacy in treatment-refractory depression, may cause nausea that requires gradual upward dosage titration. Higher doses of venlafaxine may also cause elevations in blood pressure, heart rate, and serum cholesterol. As more is learned about the pathophysiology of depression, even more specific and well-tolerated antidepressants will be developed.
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PMID:Contemporary management of depression. 799 23


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