Early response to trazodone once-a-day in major depressive disorder: review of the clinical data and putative mechanism for faster onset of action

Most antidepressants have a delayed onset of action and must be administered for several weeks to generate therapeutic effects. Trazodone is a serotonin antagonist and reuptake inhibitor approved for the treatment of major depressive disorder. The once-a-day (OAD) formulation of trazodone has an imp...

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Bibliographic Details
Published in:CNS spectrums 2021-06, Vol.26 (3), p.232-242
Main Authors: Albert, Umberto, Lamba, Pallavi, Stahl, Stephen M.
Format: Article
Language:English
Subjects:
Adrenergic receptors
Analysis of covariance
Anesthesia
Antidepressants
Anxiety
Clinical trials
Depressive Disorder, Major - drug therapy
Drug Administration Schedule
Drug dosages
Humans
Mental depression
Pharmacokinetics
Plasma
Remission (Medicine)
Review
Serotonin
Serotonin Uptake Inhibitors - administration & dosage
Serotonin Uptake Inhibitors - therapeutic use
Trazodone - administration & dosage
Trazodone - therapeutic use
Variance analysis
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Summary:Most antidepressants have a delayed onset of action and must be administered for several weeks to generate therapeutic effects. Trazodone is a serotonin antagonist and reuptake inhibitor approved for the treatment of major depressive disorder. The once-a-day (OAD) formulation of trazodone has an improved tolerability profile compared to its conventional formulations. In this study, we systematically reviewed the evidence available for the antidepressant efficacy and early improvement in depressive symptoms with trazodone OAD treatment. We conducted a PubMed database search for randomized controlled trials published from 2005 to 2020. Two studies, a placebo-controlled and an active-comparator (venlafaxine extended-release or XR) study were found. Both the studies demonstrated that trazodone exhibits antidepressant activity at a starting dose of 150 mg/day and results in statistically significant greater reduction in Hamilton Depression Rating Scale (HAM-D17) scores within 1 week of starting treatment compared to placebo or venlafaxine XR (P 
ISSN:1092-8529
2165-6509
DOI:10.1017/S1092852921000304