Trazodone: uses and side effects of this drug

Trazodone is used in a wide variety of disorders, although it is basically an antidepressant.

Depression being one of the most prevalent mental disorders worldwide and one of the major causes of disability, its treatment is an issue that the scientific community has taken into account for many years.

The suffering it generates requires immediate attention, sometimes because it is one of the disorders with the highest risk of suicide and which generates the most pain for both the person and his or her environment. The treatment of depression is carried out from different fields, one of them being psychopharmacology. One of the drugs used in the treatment of depression is trazodone, which we are going to talk about in this article.of which we are going to speak in this article.

Trazodone: what kind of substance is it?

Trazodone is a psychotropic drug classified as an antidepressant.These are substances that generate a neurochemical change in the brain, causing an alteration in the levels of certain neurotransmitters, specifically serotonin. Within the antidepressants, it is part and in fact the main representative of the group of serotonin-2A antagonists and reuptake inhibitors or SARI, a type of atypical antidepressant. This drug was designed in Italy in 1966 under the assumption that depression could be based on the existence of low thresholds regarding the perception of pain and suffering, being a product of the lack of integration of aversive experiences.

Trazodone has been shown to be an effective and efficient drug in the treatment of depression, reducing passivity and lack of activity as well as the discomfort and suffering associated with depression and facilitating an increase in mood. However, it also has an anxiolytic and tranquilizing action..

This substance is considered as a second generation antidepressant, together with specific serotonin reuptake inhibitors (SSRIs), with which it shares part of its mechanism of action, and different dual antidepressants. In fact, trazodone is sometimes considered as dual because it has two different effects, although they focus on the same neurotransmitter system, compared to the rest, and in addition to an Antidepressant effect it also has tranquilizing effects.

How does it work? Mechanism of action of the drug

As we have indicated above, trazodone is classified as a SARI, having a somewhat special mechanism of action among the other antidepressants. Trazodone acts at the level of the serotonergic system (like most antidepressants) in two specific ways.

Firstly, this substance blocks the reuptake of serotonin in the brain, so that this neurotransmitter remains in the brain. the neurotransmitter remains in the synaptic space for a longer period of time.. This means that it has an agonist effect on the synthesis and maintenance of serotonin in the brain, increasing its levels (which are decreased during depression and this is something that correlates with the decrease in mood). The aforementioned mechanism of action is the one used by SSRIs, which is why these and trazodone are related and sometimes the latter is included among the former.

However, trazodone has a second effect that differentiates it from other drugs, and in fact seems to be contrary to the previous mechanism of action. It also acts as an antagonist of serotonin 5-HT2A receptors, preventing or hindering the activation of these receptors. This second aspect is what makes trazodone's profile and effects slightly different from those of other antidepressants.

Regarding its interaction with other neurotransmitter systems, it does not exhibit strong anticholinergic effectsThis has made this drug a better option than tricyclics (although doses must still be regulated) in patients with cerebrovascular and cardiac pathology and dementia. However, it must be taken into account that it can generate arrhythmias. It also has a minor effect on the adrenergic (blocking some receptors) and histaminergic system, something that can lead to the generation of side effects.

Main indications

The main indication for trazodone is obviously, as an antidepressant, major depression. Its efficacy is also high in those depressions that appear together with anxious symptomatology. Its clinical usefulness has also been its clinical usefulness has also been observed in other disorders in which there are components of anxiety or based on it, such as generalized anxiety disorder, obsessive-compulsive disorder or bulimia.

In addition, it has also been observed to be useful in the treatment of substance addictions, being a good alternative for patients with benzodiazepine withdrawal syndrome, and in the treatment of alcoholism (including the presence of delirium tremens). Another of its indications is insomnia.It effectively reduces insomnia by increasing sleep time without greatly affecting the deep sleep phase.

While in general most antidepressants may have as a side effect the presence of erectile dysfunction or ejaculation problems, this effect does not usually occur in trazodone, which in fact seems to generate an increase in libido and which is even used as a treatment indicated for erectile dysfunction. is even used as an indicated treatment for erectile dysfunction..

Finally, trazodone has been applied (largely for its relaxing properties) in some cases of schizophrenia, motor problems such as Gilles de la Tourette syndrome, the presence of manic episodes in bipolar disorder and behavioral disturbances in Alzheimer's disease, although more study is required for the latter.

At the medical level, it has also been used as a sedative in HIV-infected patients and diabetic neuropathies, as well as in other pain disorders such as fibromyalgia. It has a very slight muscle relaxant effect.

Side effects and contraindications

Trazodone is a very useful drug that has been used in multiple pathologies and disorders, both mental and medical. However, it can have undesirable consequences in the form of side effects and is even contraindicated in some situations and pathologies.

As far as secondary symptoms are concerned, sedation and tiredness, headache, nausea and vomiting, gastric disturbances sedation and tiredness, the presence of headaches, nausea and vomiting, gastric alterations (diarrhea or constipation), alterations in appetite, sweating, tremors (which may lead to convulsions in some cases), tinnitus (diarrhea or constipation), appetite alterations, sweating, tremors (which may lead to convulsions in some cases), tinnitus, numbness and vision problems. In some cases it can also cause chest and muscle pain, alterations in consciousness, breathing problems and arrhythmias. Like other antidepressants, trazodone can also contribute to the genesis of suicidal ideation in the early stages of use.

Despite the fact that, unlike other antidepressants, it does not seem to generate but in fact contributes to improving cases of erectile dysfunction or ejaculatory problems, the use of trazodone has been observed and associated with the appearance of priapism, erections that do not disappear on their own and which generate pain for the sufferer (which may require urgent or even surgical treatment).

Although it is sometimes used in dementia and has a lower risk than tricyclics of generating cardiac problems, it requires a high degree of caution in its use and a carefully prescribed dosage by the physician, since it can generate arrhythmias. It is contraindicated in patients who have just suffered an infarctionIt is contraindicated in patients who have just suffered a heart attack, as well as in those suffering from liver or kidney disease.

Caution should be exercised in subjects with bipolar disorder, because if the medication is not regulated, the consumption of trazodone may cause a change from depressive to manic phase. It is also contraindicated in people who have had priapism or Peyronie's disease. Finally, it should be noted that trazodone can be excreted in breast milk and transmitted through the placenta, so its use is contraindicated in pregnant and breastfeeding women.