Trazodone for the treatment of sleep disorders in dementia: an open-label, observational and review study

Abstract

Sleep disorders (SD) in patients with dementia are very common in clinical practice. The use of antidepressants with hypnotic actions, such as trazodone, plays an important role in these cases. The aim of this study is to present a profile of the use of trazodone in demented patients with SD, as well as a review of trazodone hydrochloride in SD. We evaluated 178 elderly patients with Alzheimer's disease and other dementias, clinically presenting SD and treated with hypnosedative medications. In the one-year period comprising the study, 68 (38.2%) of the 178 had sleep disorders. Most patients (114; 64%) had a diagnosis of Alzheimer's disease. Approximately 85% of patients with SD used hypnosedative drugs. Trazodone was the most commonly used drug among patients (N = 35), with an effectiveness of 65.7%. Trazodone has been shown to be a good option for treatment of the elderly with dementia and associated SD. Key words: sleep, dementia, Alzheimer's disease, trazodone, antidepressant.Trazodona para o tratamento de distúrbios do sono em demência: um estudo aberto, observacional e de revisão RESUMO Distúrbios do sono (DS) em pacientes com demência são muito comuns na prática clínica. O uso de antidepressivos com ação hipnótica, como a trazodona, tem um papel importante nesses casos. O objetivo desse estudo é apresentar um perfil do uso da trazodona em pacientes com demência e com DS, bem como revisar o cloridrato de trazodona no DS. Nós avaliamos 178 idosos com doença de Alzheimer (DA) e outras demências, clinicamente apresentando DS e que foram tratados com medicações hipnossedativas. No período de um ano de estudo, 68 (38,2%) tiveram DS. A maioria (114; 64%) tinham diagnóstico de DA. Aproximadamente 85% usaram fármacos hipnossedativos. A trazodona foi a mais utilizada (N=35), com evidência de melhora de 65,7%. A trazodona mostrou-se ser uma boa opção no tratamento de idosos com demência e DS associado. Palavras-chave: sono, demência, doença de Alzheimer, trazodona, antidepressivos.

Inappropriate treatments for patients with cognitive decline

“…Among alternative maintenance treatments, we should mention mood stabiliser anticonvulsants (such as pregabalin, whose indications include generalised anxiety disorder). 14,15 Another class is constituted by antidepressants with an anxiolytic or sedative effect (especially when symptoms of depression are present): escitalopram, 16 venlafaxine, 17 duloxetine, 18 trazodone, 19,20 and mirtazapine. 21 Additional alternative treatments include melatonin (for treating behavioural changes associated with circadian rhythm disturbances) 22 ; and atypical neuroleptics previously administered to patients with this profile (for example, low doses of quetiapine, i.e.…”

Sleep disturbances and dementia

“…The origin of sleep disorders in dementia is usually multifactorial, resulting from pathophysiological changes associated with the disease itself and environmental factors. 28 For example, in a nursing home, noise and light exposure occur intermittently throughout the night and contribute to sleep disruption. 29 Other factors involve medical or psychiatric morbidity.…”

Use of hypnotics in high risk patient groups

“…Drugi hipnotici koji se mogu dati starijim pacijentima uključuju antidepresive sa hipnotičkim dejstvom, naroči-to trazodon u manjoj dozi [39], melatoninske agoniste (uključujući agomelatin kod depresivnih pacijenata), i potencijalno antipsihotike druge generacije koji imaju soporifično dejstvo (prvenstveno kvetiapin) [40]. Kod ove poslednje grupe je primetna diskrepanca između novije kliničke prakse i smernica za upotrebu koje, u najmanju ruku, ne preporučuju upotrebu u ovoj indikaciji [41].…”