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Re: Trazodone, is it good ?

Posted by Elizabeth on February 23, 2002, at 21:37:32

In reply to Trazodone, is it good ?, posted by janejj on February 21, 2002, at 0:03:57

(Sorry about the length of this message; I started out just answering the question, but then I found myself rambling about trazodone.)

I've tried using trazodone for insomnia on several different occasions. I started out at 50 mg. I found that it worked well for the first couple days, then I would have to raise the dose. Eventually I got to 400 mg and decided that was enough. Hey, if it didn't make me drowsy at 400 mg, maybe I should try it as an AD (the effective antidepressant dose range is 150-400 mg/day).

Desyrel (brand-name trazodone) was originally marketed as an AD, but the sedation was too much for it to be practical for most people, and today it's almost exclusively used as a sleep aid. It was approved in the USA in 1981, making it the first of the new-generation ADs. Unlike the TCAs, its actions targeted serotonin and not norepinephrine, although it isn't considered an SSRI because it acts at several sites in addition to the serotonin transporter (it's also a relatively weak serotonin reuptake inhibitor). Its actions include blockade of alpha1-adrenergic, H1 histaminic, and serotonergic (particularly types 1a, 1c, and 2) receptors. It has an active metabolite (m-chlorophenylpiperazine, or mCPP) that is a direct serotonergic agonist. The net effect on serotonin receptors is that of a mixed agonist/antagonist. Unfortunately, the significance of this complex combination of effects on the serotonergic system is unknown.

Trazodone was prescribed on a large scale as an AD for a brief time after it was approved, but it became apparent that the sedation made it impractical to use as an AD. When the SSRIs appeared on the market, therefore, it didn't pose any serious competition. Many pdocs have a perception that it's a weak antidepressant. There is some evidence suggesting that it may be ineffective in patients who have severe major depression with psychomotor retardation, although this is controversial. Trazodone does seem to be something of an anxiolytic. I've used it during the daytime a

I've heard of some people having nightmares or "bad trip" experiences on trazodone. Something to watch out for. (The metabolite mCPP can trigger panic attacks in susceptible individuals, and this might be responsible for these "bad trip"-like events. mCPP tends to accumulate because it has a longer half-life than trazodone itself does.)

So, there it is: more about trazodone than you ever wanted to know. Enjoy. :-}





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