The Role of Trazodone in the Treatment of Depressed Cardiac Patients

Abstract

The novel antidepressant trazodone is hypothesized to be less cardiotoxic than the tri-tetracyclic antidepressants. Recently, however, 2 patients with preexisting ventricular irritability showed an increased number of ventricular premature beats and of repetitive forms after starting on trazodone. Data are presented here from four studies on the cardiovascular safety of trazodone. Conclusions are: (1) Trazodone has little effect on cardiac conduction. (2) Trazodone does not worsen supraventricular arrhythmias. (3) Trazodone produces less postural hypotension than most other antidepressants and it tends to lower heart rate. (4) Lower doses of trazodone (100–300 mg) are better tolerated and more effective in major depressives simultaneously debilitated by significant cardiovascular disease. (5) It is possible that the so-called ‘trazodone aggravation’ of ventricular irritability is a statistical artifact – although further research is needed to verify this conclusion, and in the meantime the drug should be used with caution in such patients.

Trazodone: A 5-Year Review of Antidepressant Efficacy

“…Further study of ventricular irritability has yielded little in the way of conclusive evidence that there is any major risk that trazodone will exacerbate ventricular conduction problems [19]. Other cardiac side effects have also been reported [20], Overall, however, stud ies over the past 5 years have tended to demonstrate relatively minor nonspecific effects of trazodone on cardiac function in both healthy subjects and cardiac patients [3,4,8,19]. Nonetheless, as with any drug, patients with major arrhythmias or signifi cant underlying heart disease should be fol lowed closely.…”

Cardiovascular Toxicity of Antidepressant Medications

“…In addition, only when trazodone was used in patients with preexisting cardiac disease did reports ap pear that suggest that trazodone therapy may cause a different and potentially dangerous form of toxicity -ventricular arrhythmias [7][8][9]. Although it is not yet clear that trazo done is actually arrhythmogcnic, these stud ies suggest that trazodone may pose a prob lem and, therefore, should not be used in depressed patients with preexisting ventricu lar arrhythmia.…”

“…However, trazodone is not a perfect drug; it can cause orthostatic hypotension and has been impli cated in causing ventricular arrhythmias [7][8][9], It is currently unclear whether trazodone causes ventricular arrhythmias; thus, it would not be the drug of choice in a de pressed patient with concomitant ventricu lar arrhythmia. This article will review the TCA drugrelated cardiovascular side effects in patients with normal hearts and in those patients with cardiac disease.…”

Geriatric Depression and Treatment with Trazodone

“…Himmelhoch et al [33] reviewed the car diovascular literature and concluded that trazodone therapy had little effect on cardiac conduction, did not worsen supraventricular arrhythmias, and produced fewer incidents of postural hypotension than most other an tidepressants. Additionally, he suggested that lower doses of trazodone (100-300 mg) were better tolerated and more effective in major depressive patients simultaneously suffering significant cardiovascular disease.…”