A review of trazodone use in psychiatric and medical conditions

Trazodone is an antidepressant that is FDA-approved for the treatment of depression. It has been used by mental health and primary care providers for the treatment of multiple psychiatric and medical conditions .This review describes trazodone mechanism of action, formulation, dosage and adverse effects and then summarizes the beneficial effects of trazodone in the treatment of various psychiatric and medical conditions such as major depression, as well non-approved FDA indications such as insomnia,anxiety disorders, posttraumatic stress disorder, obsessive compulsive disorder, feeding and eating disorders, substance use disorders, behavioral disturbances associated with cognitive dysfunction, sexual dysfunction, certain pain conditions, and rehabilitation after acute ischemic stroke. Despite trazodone’s favorable effects in the treatment of FDA-unapproved psychiatric and medical conditions, large, randomized controlled clinical trials are still needed to confirm its efficacy in the treatment of the multiple conditions for which it is often used in clinical practice.     

奥氮平联合曲唑酮对甲基苯丙胺所致精神障碍患者的应用价值

目的:探讨奥氮平联合曲唑酮治疗甲基苯丙胺所致精神障碍的临床应用价值。方法:选取我院2015年1月至2016年6月期间收治的72例因吸食甲基苯丙胺致精神障碍患者为研究对象,根据入院顺序将其分为曲唑酮组(曲唑酮治疗,共36例)和联合组(奥氮平联合曲唑酮治疗,共36例),均持续治疗4周。采用阳性与阴性症状量表(PANSS)、不良反应症状量表(TESS)评估两组治疗效果,并比较两组患者生活质量(GQOLI-74)改善情况。结果:两组均成功完成治疗,无中途退出或脱落病例;两组治疗4周后,PANSS量表评分均较治疗前显著降低(t=17.380,25.906;P0.05),与曲唑酮组相比,联合组PANSS量表评分降低更为明显(t=8.943,P0.05);两组均取得一定积极疗效,联合组疗效明显优于曲唑酮组(Z=2.212,P0.05);两组治疗不良反应率相较无显著差异(χ~2=1.000,P0.05),但联合组治疗后TESS评分明显低于曲唑酮组(t=2.254,P0.05);两组治疗后GQOLI-74量表评分较治疗前均有明显提高(t=2.406,5.700;P0.05),和曲唑酮组相比,联合组GQOLI-74量表评分提高更为显著(t=3.117,P0.05)。结论:奥氮平联合曲唑酮治疗甲基苯丙胺致精神障碍临床疗效较好,有助于改善患者精神障碍症状和提高生活质量,且联合治疗并不增加药副反应,值得临床推广应用和深入研究。     

曲唑酮治疗抑郁症伴发勃起功能障碍的临床研究

目的:观察曲唑酮对抑郁症患者伴发勃起功能障碍(ED)的疗效及安全性。方法:选择91例抑郁症伴发勃起功能障碍的患者,在原有抗抑郁药物不变的情况下,随机分为实验组46例(合并曲唑酮治疗),对照组45例,疗程6周,于治疗前及治疗后第1、2、4、6周采用勃起功能国际指数评分问卷(IIEF-5)及副反应量表(TESS)评定疗效及不良反应。结果:实验组抑郁症患者勃起功能障碍用曲唑酮治疗的显效率为58.60%,对照组为21.14%,差异具有显著性(P<0.01),实验组IIEF-5评分于第4周末即显著高于对照组,TESS两组比较无显著差异。结论:曲唑酮可显著改善抑郁症患者的勃起功能,安全性高,值得临床应用。     

反相高效液相色谱测定L-色氨酸及氯哌三唑酮的含量(英文)

用反相高效液相色谱系统在无需预先去除干扰物质的条件下同时测定制剂中L-色氨酸和氯哌三唑酮的含量,方法简单可靠,重现性好(CV<1%)。两组分在测定波长246nm和278nm处标准曲线的相关系数大于0.9998,系统精确度的变异系数在1.25～2.95%。实验结果还表明本法分辨率高,可避免某些在测定波长有吸收的辅料(如尼泊金甲酯、尼泊金乙酯等)以及降解产物的干扰。因此,本法不仅可用于测定含有干扰物质制剂中L-色氨酸及氯哌三唑酮的含量,而且也可用于诸如制剂稳定性的预测等研究。     

Steroid-dependent form of Kinsbourne syndrome: successful treatment with trazodone

We report the case of a 19 month old girl with myoclonic encephalopathy of infants (MEI) (Kinsbourne syndrome), on long-term therapy with ACTH for the occurrence of frequent relapses (steroid-dependent form). The administration of trazodone per os at low doses as an alternative to the previous treatment ensured complete remission, also on the occasion of a subsequent relapse. No rebound effects were observed after trazodone withdrawal (10 months). At present, 3 years after withdrawal of the therapy, the child is well and free from symptoms. The hypothesis that trazodone may be effective in treating MEI, at least in cases that are steroid-dependent or resistant to ACTH, appears highly interesting. Trazodone is proposed as a possible alternative to treatment with ACTH.

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Sommario Viene segnalato il caso di una bambina di 19 mesi affetta da encefalopatia mioclonica infantile (EMI) (Sindrome di Kinsbourne), in trattamento cronico con ACTH per le frequenti recidive (forma steroido-dipendente).La somministrazione di trazodone per os, a basse dosi, in alternativa al trattamento precedente, ha consentito di ottenere la remissione completa, anche nel corso di una successiva ricaduta. La sospensione del trattamento (dopo 10 mesi) non si è associata a fenomeni di recidiva; attualmente, a 3 anni dalla sospensione, la bambina sta bene ed è libera da sintomi. Appare suggestiva l'ipotesi dell'efficacia del trazodone nella EMI, almeno in casi steroido-dipendenti o resistenti all'ACTH. Il trazodone viene proposto come possibile alternativa al trattamento con ACTH.

     

阿米替林、美舒郁对血流动力学影响的脉图检测研究

目的　观察研究阿米替林、美舒郁造成的血流动力学改变 ,对比 2药对心血管功能的不同影响。方法　把符合条件的 2 0 8例抑郁症患者 ,随机分成两组 ,一组用阿米替林治疗 ,一组用美舒郁治疗 ,并在用药前及用药后 1周末、2周末、4周末用血液循环动力学脉图检测仪检测病人的血流动力学参数 ,观察项目 :HR、ECV、MEC、LME、MIT、MVO。结果　阿米替林组 1周末即有 MIT改变。自 2周末各个参数均出现明显差异 (P<0 .0 5 ) ,到 4周末 ECV、LME、MVO的改变尤为明显(P<0 .0 0 1 )。而美舒郁组只有 LME 4周末有明显降低 (P<0 .0 5 )。结论　美舒郁抗抑郁治疗时对心脏的影响较小 ,而阿米替林对心脏有明显的影响 ,表现为心率加快 ,有效循环血容量降低 ,心肌耗氧量明显增加 ,心肌供血障碍 ,左室效能降低 ,同时 ,用药时间越长 ,剂量越大 ,对心脏的影响越明显     

Trazodone in late life depressive states: a double-blind multicenter study versus amitriptyline and mianserin

Seventy five elderly depressed in-patients, ages ranging from 60 to 83 years, diagnosed as Major Depression according to DSM III were treated, under double-blind conditions, with 75 mg Amitriptyline (AMI) (26 patients), 60 mg Mianserin (MIA) (24 patients) or 150 mg Trazodone (TRZ) (25 patients) p.o. for 5 weeks. There were no differences in the clinical outcome between the three groups of patients at the end of the trial, with a significant amelioration (P<0.01) at the Hamilton Rating Scale for Depression and Geriatric Depression Scale. TRZ showed a significantly lower incidence of side effects compared to MIA and AMI. Atypical antidepressants, including TRZ, seem more suitable for treating elderly depression than the first generation antidepressants on the basis of risk/benefit ratio considerations.     

曲唑酮治疗老年苯二氮卓类药物依赖患者临床观察

目的 探讨曲唑酮对老年苯二氮卓类药物(BZD)依赖患者替代治疗的疗效及对认知功的影响.方法 对51例老年BZD依赖患者采用剂量快速递减、曲唑酮替代疗法,14d内停用BZD,之后睡前顿服曲唑酮,连服6个月.采用匹兹堡睡眠质量指数(PSQJ)量表和副反应量表(TESS)评定临床疗效和不良反应.选用韦氏成人智力量表( WAIS-RC)、韦氏成人记忆量表(WMS-RC)评定认知功能.疗效和不良反应于治疗前后评定;认知功能于治疗前后各评定1次.结果 PSQJ总分[(13.17 ±3.70)分,(11.05±3.48)分]、睡眠质量[(2.36±0.33)分,(1.91 ±0.29)分]、睡眠障碍、日间功能障碍分疗后低于疗前(P＜0.05),其他成份分无差异.曲唑酮副反应少而轻,更无依赖发生.认知功能中的知识、算术、数字符号、木块拼图、长时记忆、短时记忆、即刻记忆及记忆商数分方面疗前均低于疗后(P＜0.05).结论 曲唑酮可作为老年失眠患者的理想药物.     

曲唑酮治疗老年期抑郁症的研究

目的 探讨曲唑酮治疗老年期抑郁症的疗效.方法 60例符合诊断标准的老年期抑郁症患者随机分为曲唑酮组和文拉法辛组,疗程8周.采用汉密尔顿抑郁量表(HAMA),评定疗效.采用治疗中需处理的不良反应症状量表(TESS)评定安全性.结果 在第1周末研究组(曲唑酮组)有效率为30.00%;对照组(文拉法辛组)有效率为10.00%.两组有效率有显著性差异(X2=3.85、P＜0.05).治疗8周末研究组总有效率93.33%,对照组总有效率86.67%,两组总有效率无显著性差异(X2＝0.187、P＞0.05),说明两者总体疗效相当.两组TESS评分在治疗后1、2、4及8周末差异均无统计学意义(P＞0.05).结论 曲唑酮治疗老年期抑郁症起效快,安全性好,副作用少.