November 29, 2022

The only FDA approved use of trazodone is for depression. However, this medication is rarely prescribed for this purpose. The higher dose requirements and lower affinity for the serotonin transporter allows the side effect profile to make the medication intolerable for most patients.

What’s up everybody dr rossi shrinks and i’ve been doing a series where i’m covering the most commonly prescribed medications and when i looked at the list of these most commonly prescribed medications for psychiatric or mental health purposes i was not surprised at all to see this medication on the list and that’s because this is commonly prescribed

For multiple reasons and we’ll get into exactly why those things are so the medication we’re covering today is trazadone and i’m going to explain a little bit about the mechanism i’m going to talk about some of the uses of this medication as well as how to dose it and what are some of the potential side effects as well to using this medication so transidone is

Only fda approved for depression specifically for the treatment of depression however this medication is rarely prescribed for that purpose basically most people have trouble staying on the medication at the doses required to treat depression and that’s because of some of the side effect profiles specifically sedation that’s associated with taking the medication

During the day so a lot of the cases the most common way you see this medication used is as an adjunctive therapy for sleep disturbances in major depressive disorder or as a primary a treatment for primary insomnia so it can also be used to help with sleep for primary insomnia a few of the other uses that i think people are not really aware of but they’re ways

That i like to use this medication occasionally depending on my patient and depending on the circumstances so i will actually use this medication for people with ptsd post traumatic stress disorder related sleep disturbance and nightmares although it’s not the same as prosocian which is a medication specifically targets the nightmares and has has had some

Pretty good studies from the um from the va it still has a lot of benefits and i’ve had great good success clinically with the treatment of ptsd related sleep disturbances as well as nightmares so that’s one additional way that you can use this outside of depression and primary insomnia the other areas to talk about here is definitely primary insomnia because

Although it’s not fda approved for that reason it does seem to help and how does it help it increases total sleep time by 30 to 50 minutes and it also increases that deeper slower wave sleep that we see in stages two and three or what we call non-rem stage two and non-rem stage three so increases deep sleep increases total sleep time and can be used to treat

Primary insomnia now this is the preferred hypnotic for a patient with sleep apnea so if you’ve ever treated a sleep disturbance in a patient with sleep apnea you have to be really careful a lot of the things like the z drugs or the benzodiazepines are off the table for these patients so you have to use something that’s a that’s a sedating antidepressant usually

Namely mertazapine or trazadone so transcendent nicely here for people with sleep apnea you want to avoid this medication in any patients that have a diagnosis of sickle cell anemia you want to also avoid it in leukemia any type of hypercoagulable states and you also want to which this is maybe not something most people are aware of but you also want to avoid

This medication people who are using cocaine or methamphetamine stimulant based drugs the mechanism of action is slightly different than what you might see in other antidepressants so primarily it’s actually blockade of serotonin 2a receptors so it’s going to block the serotonin 2a receptors which isn’t that much different than other antidepressant medications

But most of the other ones we talk about are usually serotonin reuptake inhibitors so they’re blocking the serotonin reuptake pump not necessary and this does do that too but to a lesser degree than what you would see with other medications so that’s one of the big differences it’s primarily 5 ht2a blockade but also has serotonin reuptake pump blockade as well

So it works by both mechanisms but lower affinity for the serotonin reuptake pump now the dosing of this medication a lot of times it depends on what we’re treating and that will dictate how we dose the medication so to take advantage of the sedating properties of the medication let’s say i want to use it for primary insomnia i want to use it for sleep related

Disturbances and depression i’ll dose it anywhere from 25 to 150 milligrams per night and i will usually keep it low and the lower the better because again that takes advantage of the side effect profile which is what we’re trying to do when we’re trying to get those sedating effects so for depression though the patient will have to take a much higher dose and this

Is why people have trouble taking this as an as a primary antidepressant because the dose is going to be anywhere from 150 to 600 milligrams a day so this is kind of a wide range and of course you’ve got to titrate up and you’re going to break it down into multiple divided doses so if i’m doing this for depression you want to usually start with 150 milligrams per

Day in divided doses and that’s because it has a short half-life so with a short half-life we need to do multiple days of dosa multiple times per day of dosing which is different and that’s why i talk about the use of extended release and things of that nature so short half-life medications require multiple times per day require you take it multiple times per

Day and you can increase this dose every three or four days by 50 milligrams per day so every three to four days you can titrate up to 50 milligrams as needed and you want to chart target a dose of approximately 400 milligrams per day if you’re treating depression again for insomnia it’s much lower you might be able to get away with 25 to 50 milligrams at night

And then a target dose of 50 to 100 milligrams per night for insomnia or sleep disturbances related to depression again not using it as a primary antidepressant it’s very important to start low with this medication and go slow that is the motto we use often in psychiatry start low and go slow it helps us to avoid side effects and one of the big side effects that

With this is that people can have increased feelings of sedation so we want to start low and we don’t want them to feel overly sedated and we don’t want to carry over sedation ataxia or intoxicated like feelings when the patient wakes up in the morning if we go too fast so what we find is if you titrate this medication too fast you run into those kind of problems

You also don’t want to stop this medication prematurely uh often for difficult to treat patients and if you’re using this again as your primary antidepressant medication you need a much higher dose probably somewhere between 150 and 300 milligrams but in some cases all the way up to 600 milligrams or even 800 milligrams depending on the circumstances so it really

Will depend on the clinical picture with the patient but this is an important point not to stop too early it’s ideal to dose this at night again before bed because of this the risk of daytime sedation so if you can take the dose at night for sleep again that 25 to 150 milligram dose somewhere in that range it’s going to be ideal to do that before bedtime to avoid

The daytime days some of the notable side effects i want to talk about because this is important and this actually has a better side effect profile than some of the other antidepressants we’ve talked about in the past so notable side effects nausea vomiting constipation dry mouth dizziness of course sedation and fatigue headaches and the one that really comes

Up with this and they used to in medical school they used to have trash a bone and that was because of its propensity to cause something called priapism which is a painful erection lasting two to four hours so if somebody is to have this side effect of privatism it’s a life-threatening emergency and they need to go to the emergency department immediately so

You wanna look out for that and that occurs roughly in one to six thousand to one to eight thousand men and it depends on what study you read there’s some differences there of opinion on the actual numbers but somewhere around one to eight thousand men let’s say will experience this potential side effect other life-threatening side effects include seizures and

Possibly in patients under the age of 24 the activation of suicidal ideation and that’s a point we should really definitely talk about because people often misunderstand what that means so maybe a future topic in a video if people are interested obviously significant sedation is possible and weight gain of course comes along with sedation if you’re not moving and

You’re too tired all the time you’re simply going to gain weight so we want to watch out for weight gain with this medication as well the onset of therapeutic actions for insomnia actually are immediate so this is really nice this is one benefit normally with antidepressants we have to wait you know four weeks six weeks to start to see the full effect with this

Medication when you’re talking about insomnia it is immediate you’re gonna have benefits right away as long as you’re taking an adequate dose there’s also another very important point about this because like i said a lot of the medications we use for sleep are things like benzodiazepines or z drugs there’s no evidence for tolerance abuse potential or withdrawal

With trazadone so no addictive potential of using for using this medication so there’s no addiction risk when you’re prescribing trazadone another reason it makes it a great hypnotic now the therapeutic action of course of the antidepressant effects is delayed by about two to four weeks and if it’s not working by six to eight weeks you want to consider a dosage

Increase or switching depending on the circumstances so to wrap this video what i’ll say is i actually like transdone as a medication the place that i trained at actually saw it being so good that they actually keep it as a prn medication for patients who come to the inpatient unit it’s available to help with sleep so tracidone offers a non-addictive option for

Insomnia treatment it can be used as an adjunct treatment to depression or for a primary treatment of depression it can also be used to treat the ptsd nightmares and sleep disturbances created by ptsd it can also be used for primary insomnia in patients who are dealing with that disorder it’s less likely than other antidepressants to cause sexual dysfunction

And it’s less likely to precipitate hypomania if you were to give this medication to somebody with a diagnosis of bipolar disorder there is also some evidence to suggest it may help with patients who have dementia who come into the hospital and possibly become delirious and this can help with treating agitation and aggression in those patients with dementia so

There’s some evidence to support that in the literature as well and the other benefit like i already kind of alluded to was this is there’s no evidence for tolerance abuse or withdrawal so it doesn’t it’s a non-addictive option to help people sleep tracidone is also a good option which this is not really known for people who have failed to prior antidepressants

So someone who might be quote treatment resistant or go or leaning towards the spectrum of treatment resistant depression transcendent actually might be a good option to try in that patient if they don’t want to try medications like tricyclic antidepressants or maoi inhibitors which can be a little bit more difficult from a side effect profile and a little more

Dangerous for patients with cardiac disease and or who are elderly with that said i’m going to wrap the video there if you guys have questions about trouser don’t drop them below in the comments section and please like and subscribe to this channel so we can continue making videos just like this

Transcribed from video
Most Commonly Prescribed Psychiatric Medications: Trazodone By Shrinks In Sneakers