Trazodone: a multifunctional antidepressant. Evaluation of its properties and real-world use

Trazodone is indicated for the treatment of Major Depressive Disorder (MDD), often associated with anxiety, insomnia, agitation, nervousness, or irritability.The aim of this review was to summarise the pharmacological proper- ties of trazodone in improving depressive symptoms in elderly patients and in patients with neurological comorbidities, for whom secondary depression is often present.Five different pharmaceutical formulations of trazodone are available: intravenous or intramuscular liquid solution, immediate-release tablets (I.R.), oral drops, prolonged-release tablets (P.R.), and extended-release Contramid® tablets (COAD). The initial dose of trazodone should range from 75 to 100 mg/day. For COAD formulation, the starting recom- mended dose is 150 mg once daily. In elderly patients, trazodone may be administered at very low dosages (25-50 mg/day for I.R. formula- tion, and 50-100 mg for the P.R. or E.R. formulations). The maximum daily dose should not exceed 300 mg/day, split over two administra- tions across the day.In elderly patients, trazodone has reported excellent results, keeping high-quality standards for safety and tolerability. It can help to improve insomnia and anxiety without resorting to benzodiazepines. In patients with neurological conditions, trazodone helps to treat anxiety-depres- sive symptoms. In patients with Alzheimer’s disease or frontotemporal dementia, trazodone can help to handle behavioural symptoms, also acting as a putative neuroprotective agent.Trazodone is well tolerated. Somnolence/sedation, dizziness, consti- pation, and blurred vision are common side effects with an incidence slightly greater than 5%. Orthostatic hypotension and headache are relatively common side effects.The great availability of formulations allows to personalise trazodone administration according to patient profile characteristics.