A lasting change in trazodone response after non-convulsive electroshock therapy for medication-resistant senile depression

Abstract A senile patient showed a dramatic recovery from medication-resistant depression after non-convulsive electro-shock therapy (nc-EST), with a lasting change in response to trazodone, which mainly acts as a serotonin re-uptake inhibitor. This result suggests that a change in the serotonin reuptake mechanism may be involved in the effect of nc-EST on depression.     

Two cases of obsessive-compulsive disorder with depression responsive to trazodone

Two patients with severe obsessive-compulsive disorder with superimposed depression, who had failed to respond to a wide variety of antidepressants, were treated with trazodone hydrochloride. Both seemed to obtain a rapid and impressive improvement in both their depression and obsessive-compulsive disorder while receiving trazodone. One patient subsequently had a monoamine oxidase inhibitor added to his treatment and experienced some additional improvement, but most of his improvement had occurred earlier, while he was receiving trazodone only.     

Priapism associated with trazodone therapy: case report

A case of priapism associated with trazodone is described. Erection subsided spontaneously after 4 hours, with subsequent potency unimpaired. No published reports of priapism with antidepressants were located, but 11 cases have been reported to the manufacturers.     

Fluoxetine versus trazodone in the treatment of outpatients with major depression

Fluoxetine and trazodone were compared in a double-blind, randomized, parallel, 6-week trial in 43 outpatients with major depression after a 1-week single-blind placebo period. Thirty-five patients completed at least 3 weeks of active medication, while 25 patients completed all 6 weeks. Response rates, whether defined by end-of-treatment Hamilton Rating Scale for Depression (HAM-D) score less than 10 or by a 50% reduction in HAM-D scores, were equivalent for the two medications. For fluoxetine, HAM-D scores were significantly lower at Weeks 1 and 2 compared with those of trazodone. Trazodone improved sleep significantly more than fluoxetine. Fluoxetine was associated more frequently with weight loss (p = .002) and less frequently with dizziness (p = .04) than trazodone.     

Erythema multiforme associated with trazodone therapy: case report

A 63-year-old woman with treatment-resistant depression was started on trazodone and subsequently developed erythema multiforme (EM), with lesions predominant on the distal parts of the limbs and involvement of the hands and feet, as well as her palms and soles. The patient's treatment course and subsequent remission are described. It is suggested that trazodone therapy be discontinued immediately upon notice of EM. This patient was also taking lithium, which has not been implicated in erythema multiforme.     

A comparative trial of fluoxetine versus trazodone in outpatients with major depression

The effectiveness of fluoxetine as an antidepressant was contrasted with trazodone in a 6-week double-blind trial in 40 patients. The total score on the Hamilton Rating Scale for Depression and the global improvement score on the Clinical Global Impressions scale favored trazodone at the end of 3 weeks of treatment. However, that difference was no longer apparent during the remainder of the study. The authors hypothesize that fluoxetine 20 mg/day may be an ineffective dosage of the drug or that fluoxetine has a slower onset of antidepressant action than does trazodone.     

曲唑酮治疗失眠及其相关抑郁、焦虑的专家 共识

失眠是临床常见症状,多与抑郁和焦虑障碍等精神疾病同时或相继发生,且临床上常难 以界定两者之间的因果关系。鉴于失眠与抑郁、焦虑存在的交互作用,对抑郁、焦虑和失眠进行综合干 预和管理成为目前疾病治疗的新趋势。曲唑酮是一种具有镇静催眠作用的抗抑郁药,临床广泛用于失 眠及抑郁焦虑伴发或共病失眠的患者。为规范曲唑酮在失眠领域的应用,编写共识的专家组成员通过 复习曲唑酮相关文献,同时结合国内外指南的推荐,重新总结了药物的药代动力学数据、药理作用及相 关临床应用方法,并经过专家组的反复讨论达成共识,以期为广大临床医师合理使用该药提供参考。     

曲唑酮与文拉法辛治疗抑郁症的对照研究

目的　评价曲唑酮治疗抑郁症的临床疗效和副反应。方法　对 72例抑郁症患者随机分为曲唑酮组 (36例 )与文拉法辛组 (36例 )进行对照性研究 ,疗程 8周 ,采用汉密顿抑郁量表 (HAMD) ,汉密顿焦虑量表(HAMA)、临床总体印象量表 (CGI)及副反应量表 (TESS)评定疗效及副反应。结果　曲唑酮与文拉法辛的临床疗效相似 ,两组的显效率和有效率分别为 6 1%、78%与 6 1%、81% ,差异无显著性 (P >0 0 5 ) ,副反应两组间差异也无显著性 (P >0 0 5 )。结论　曲唑酮与文拉法辛相比 ,在治疗抑郁症方面 ,有相似的疗效和安全性     

A combination of hypothalamic phospholipid liposomes with trazodone for treatment of depression. An open controlled study

In an open controlled trial of 48 patients with major depression illness (according to DSM-III), the patients were randomly assigned to 2 groups. One group of 25 patients was treated with 200-300 mg/day of trazodone and a second group of 23 patients was treated with 200-300 mg/day trazodone plus 1 ampoule (corresponding to 1000 gamma of lipidic phosphorous) twice daily of hypothalamic phospholipids (HPL). The effectiveness of treatment was evaluated by the Hamilton Rating Scale for Depression (HRSD). Side effects of treatment with trazodone were looked for by measuring systolic and diastolic blood pressure and heart rate and from EEG made before and on the 7th and 30th days of treatment. Combination with HPL shortened the typical latency of action of the antidepressant trazodone, definitely improved the subjective symptoms, especially the psychosomatic symptoms, on the HRDS and decreased the incidence of such side effects of trazodone as hypertension, reflex tachycardia and asthenia.     

Electroconvulsive therapy and cardiovascular complications in patients taking trazodone for insomnia

BACKGROUND: Trazodone has been used widely to treat insomnia in depressed patients. When used in combination with electroconvulsive therapy (ECT), trazodone has been suspected to cause cardiovascular side effects. METHOD: A retrospective study was done of 100 patients who received ECT with concurrent trazodone. One patient was excluded because permission to review the patient's records had not been given. The remaining 99 patients were matched with control ECT patients. RESULTS: No statistically significant between-group differences were identified in cardiovascular side effects, although a trend toward more orthostatic hypotension was observed in patients taking trazodone. CONCLUSION: Administering low-dose trazodone for insomnia in conjunction with ECT does not appear to increase cardiovascular complications. The true incidence of adverse cardiac events was not higher than 3.66% at a 95% confidence level.     

曲唑酮与阿米替林治疗抑郁症对照研究

目的:探讨曲唑酮对抑郁症的疗效。方法:将80例患者随机平分为两组,分别给予曲唑酮和阿米替林治疗,疗程4周。用汉密尔顿抑郁量表(HAMD)和副反应量表(TESS)评定疗效和不良反应。结果:治疗4周后,两药对抑郁症均有良好疗效,疗效近似(P>0.05);但曲唑酮不良反应小,程度轻(P<0.05或P<0.01)。结论:曲唑酮治疗抑郁症安全,疗效确切。     

Combined use of trazodone and phenelzine in depression: case report

A patient with an 18-year history of depression was treated with a combination of trazodone and phenelzine without any major complications and with good efficacy. The use of this medication combination has not been reported previously.     

氟西汀与曲唑酮治疗抑郁症迟滞与精力缺乏症状的对照研究

目的 比较氟西汀与曲唑酮治疗抑郁症迟滞与精力缺乏症状患者的疗效.方法 在中国4家医院收集了120例同时符合DSM-Ⅳ抑郁症诊断标准和Hamilton抑郁量表（HAM-D）中迟滞因子分≥8的患者.患者被随机分配至氟西汀组（61例）或曲唑酮组（59例）,氟西汀剂量20～80mg/d,曲唑酮剂量100～300mg/d,治疗6周.于基线治疗前一天、治疗后第1、2、4、6周时分别评定疗效与安全性.结果 以HAM-D总分的减分率、HAM-D迟滞因子分的减分率评定疗效,氟西汀组（治疗4周末和治疗结束时分别为55%,83%）的有效率均高于曲唑酮组（治疗4周末和治疗结束时分别为33%,49%,P＜0.01）.两组的不良反应（不良事件总的发生率及与药物相关的不良事件的发生率,氟西汀组为34%和5%,曲唑酮组为39%和27%）发生率无差异（P＞0.05）.结论 氟西汀治疗抑郁症迟滞症状群的疗效优于曲唑酮,提示镇静作用弱的抗抑郁药对于有迟滞与精力缺乏症状的抑郁症患者具有优势.     

Long-term outcome after ECT for catatonic depression

INTRODUCTION: This is the initial report of the course of major depression with catatonic features after hospitalization. METHOD: Telephone interviews and ratings were conducted 3-7 years after response to inpatient electroconvulsive therapy (ECT) for such catatonic depression. This was done for all 19 followable patients treated over a particular 4-year period. All had received left anterior right temporal brief-pulse ECT. Prior to data examination, we constructed rules to classify medications as antimelancholic. These rules led to the inclusion of lithium, tricyclics, bupropion, and venlafaxine in this antimelancholic classification and to the exclusion of selective serotonin reuptake inhibitors. RESULTS: Ten of the 13 patients discharged on antimelancholic medication (AMM) had good function on follow-up and no more than one rehospitalization. In contrast, none of the six patients in the other group had as good an outcome (p = 0.004, corrected chi2 = 8.26). The AMM group had no deaths, but three patients in the other group died of acute cardiopulmonary causes (p = 0.015). In most cases, catatonia and depression were not identified by informant interview on follow-up. DISCUSSION: ECT followed by AMM usually led to long-term outcome that was good and better than without such medication. Although benzodiazepines can acutely diminish catatonia, we found no relevant long-term study; accordingly, long-term benzodiazepine use in catatonia is speculative.     

Long-term follow-up of chronic depression treated with imipramine

A long-term follow-up assessment was conducted in 25 chronically depressed patients who had participated in a 6-week trial of imipramine to determine if imipramine responders would sustain a more favorable long-term outcome than nonresponders or noncompleters. Imipramine responders tended to remain on imipramine treatment throughout the follow-up interval and had a significantly better outcome. Eighty-nine percent of the imipramine responders met the criteria for recovery at follow-up compared with 31% in the comparison groups. Imipramine responders also fared significantly better at follow-up on measures of depression, global severity of illness, and social/vocational functioning. The results supported a more favorable long-term outcome in chronic depression patients who had responded to imipramine and suggest that maintenance therapy may be indicated and effective for this disorder.     

Long-term maintenance therapy for major depressive disorder with rTMS

OBJECTIVE: There is growing evidence to support the short-term antidepressant effects of repetitive transcranial magnetic stimulation (rTMS), but few published data pertain to the maintenance treatment of patients with DSM-IV-diagnosed major depressive disorder who have responded acutely to rTMS. We describe long-term maintenance therapy for major depressive disorder with rTMS. METHOD: Repetitive transcranial magnetic stimulation was applied in 10 adults over the left prefrontal cortex at 100% of motor threshold, most often at a frequency of 10 Hz for sessions consisting of 40 trains at 5 seconds per train (2000 pulses per session), for periods ranging from 6 months to 6 years. Session frequency averaged 1 to 2 per week. The study was conducted in the TMS lab of an academic medical center. RESULTS: Seven of the 10 subjects experienced either marked or moderate benefit, which was sustained without the addition of concomitant antidepressant medication in 3 cases. There were no serious adverse events reported by any participant. The seizure rate for the 1831 reported rTMS sessions was zero. CONCLUSIONS: These data, while open label, suggest that maintenance rTMS may be a safe and effective treatment modality in some patients with unipolar depression. Further research into the long-term safety and efficacy of rTMS is warranted.     

帕罗西汀合并小剂量曲唑酮治疗伴勃起功能障碍抑郁症的对照研究

目的探讨帕罗西汀合并小剂量曲唑酮对伴有勃起功能障碍(ED)抑郁症患者的疗效及安全性。方法将101例伴有勃起功能障碍的抑郁症患者随机分为研究组(50例)和对照组(51例),研究组在常规给予帕罗西汀治疗的基础上,合并小剂量曲唑酮,对照组仅给予帕罗西汀,疗程6周;于治疗前及治疗后1、2、4、6周采用汉密顿抑郁量表(HAMD)、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、勃起功能及副反应。结果对抑郁症状的治疗,2组疗效相当,研究组显效率为86.0%,对照组为78.4%;但1周末及2周末研究组HAMD评分显著低于对照组(P<0.05)。对勃起功能,2组的显效率分别为56.0%、21.6%,差异具有显著性(P<0.01);研究组的IIEF-5评分于4周末即显著高于对照组;ED改善与HAMD阻滞因子减分值呈正相关。2组间TESS评分无显著性差异。结论帕罗西汀合并小剂量曲唑酮治疗抑郁症起效快,且可显著改善患者的勃起功能,安全性高。