Trazodone in Treatment-Resistant Depression: An Open Study

Abstract

Trazodone was well tolerated and reasonably effective in a group of 25 treatment-resistant depressed patients. Three patients dropped out of the study during the first week because of side effects. Of the 22 patients who completed 2 or more weeks on trazodone, 63% showed at least a 50% reduction in Hamilton Rating Scale for Depression (HAM-D) score for at least two consecutive weekly rating periods. The group had significant decreases in HAM-D, Brief Psychiatric Rating Scale, and Profile of Mood States Depression Factor scores by the end of the first week of treatment. A few patients who did not respond during the initial 4 weeks of the study did so after 2 or 3 months (after 4 weeks, ratings were done monthly). Side effects were not generally a problem. Sedation occurred in 46% of the patients but was easily managed. Anticholinergic side effects were absent, and hypotension was present only if patients took large doses on an empty stomach. Perhaps because the trazodone dosage was generally not raised rapidly, three more severely depressed patients did not respond. The three patients on stable maintenance lithium prior to starting trazodone also failed to improve. On the other hand, no exacerbation of psychosis or precipitation of mania or hypomania occurred on trazodone.