Treating Depression in Clinical Practice: New Insights on the Multidisciplinary Use of Tradozone

Abstract

Depression is estimated to be a leading contributor to the global mental health-related burden. The determinants of this huge prevalence lie in the fact that depressive symptoms may be comorbid in a wide variety of disorders, thus complicating and exacerbating their clinical pictures. This makes the treatment of depressive symptoms even more difficult since many pharmacological and pharmacokinetic interactions should be considered by physicians approaching the therapy. Hence, depression still represents a challenge for both psychiatrists and the other clinicians, in terms of its high rates of relapse and resistance despite well-established protocols. It is also complicated by the well-known latency in its complete response to current antidepressant treatments. In this context, the search for new strategies in antidepressant treatment is mandatory; even including revising the use of “old” pharmacotherapies by considering their specific features may help to perfecting the treatment of depression, both in its standalone psychiatric manifestation and in the framework of other clinical conditions.
 The results of a consensus of experts regarding the possible use of trazodone as a valuable strategy for addressing the “real world” unmet needs of depression treatment is herein reported. This is based on the unique characteristics of this drug possibly delivering a rapid antidepressant action as compared to other selective serotonin reuptake inhibitors (SSRIs) as well as on its pharmacodynamic malleability and pharmacokinetic tolerability when used in the milieu of other drugs in treating comorbid depressive symptoms.

TED (Trazodone Effectiveness in Depression): effectiveness of trazodone extended-release in subjects with unsatisfactory response to SSRIs

“…Trazodon jest również antagonistą 5HT2 A/C, co zapobiega ograniczeniu przekaźnictwa noradrenergicznego i dopaminergicznego w korze przedczołowej z powodu zwiększonej stymulacji serotoninergicznej, co jest uważane za mechanizm wyjaśniający spłycenie emocjonalne i ograniczoną skuteczność SSRI w łagodzeniu anhedonii. Ponadto blokada 5HT2 A/C może zapobiegać wystąpieniu lub ograniczać nasilenie i ryzyko zaburzeń seksualnych wywołanych blokadą wychwytu serotoniny, a w połączeniu z antagonizmem receptorów H1 i α1 adrenergicznych promuje działanie nasenne i anksjolityczne trazodonu [14][15][16]. Jak pokazano w analizie pilotażu tego badania, trazodon XR wykazał się dobrym działaniem przeciwdepresyjnym w MDD, nie tylko w redukowaniu nasilenia objawów depresji, ale także przez poprawę anhedonii, funkcji seksualnych, snu i ogólnego funkcjonowania [17].…”