Results from double-blind studies reported since 1981 were reviewed to evaluate trazodone’s relative antidepressant efficacy and its safety profile. Trazodone’s therapeutic efficacy compared favorably with that of the tricyclic antidepressant (TCA) agents in both endogenous and nonendogenous patients. Data also suggested that trazodone had a more pronounced, earlier anxiolytic action than the TCA agents. Trazodone may be more effective at lower than maximal doses; some studies that used high dosages-starting at 200 mg/day and rapidly titrated doses to as high as 600 mg/day–reported poorer therapeutic responses than did those that employed more conservative dosages. Trazodone therapy generally produced less pronounced anticholinergic effects than did the comparison TCA agent and it is often as sedating as amitriptyline but more sedating than imipramine. Untoward side effects may be reduced by taking trazodone after meals, and by using bedtime dosing. Issues of possible cardiotoxicity and priapism are reviewed briefly. Overall, studies in the past 5 years point to trazodone as being an effective antidepressant agent with a relatively favorable safety profile.

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