Categories: Side effects

Contraindications and side effects of Trazodone

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Discover the Contraindications and side effects of Trazodone.

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

Contraindications and side effects of Trazodone

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Being depression one of the most prevalent mental disorders worldwide and one of the major causes of disability, its treatment is a matter that the scientific community has taken into account for many years.

The suffering it generates requires sometimes immediate attention since it is one of the disorders with the highest risk of suicide and that generates the most pain both for the person and for those around him.

The treatment of depression is carried out from different areas, one of them being psychopharmacology.

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One of the drugs used in the treatment of depression is trazodone, which we are going to talk about in this article.

Trazodone: what type of substance is it?

Trazodone is a psychotropic drug classified within antidepressants, substances that generate a neurochemical change at the brain level, causing alterations in the levels of certain neurotransmitters, specifically serotonin.

Among antidepressants, it is part and is the main representative of the group of serotonin-2A antagonists and reuptake inhibitors or SARIs, 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 the product of the lack of integration of aversive experiences.

Trazodone has proven to be an efficient and effective drug in the treatment of depression, reducing passivity and inactivity, as well as the discomfort and suffering associated with said ailment, and facilitating an increase in mood.

However, in addition to this, it also has an anxiolytic and tranquilizing action.

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This substance is considered a second-generation antidepressant, along with specific serotonin reuptake inhibitors (SSRIs), with which it shares part of its mechanism of action, and different dual antidepressants.

Trazodone is sometimes considered to be dual as it has two different effects, although they focus on the same neurotransmission system, compared to the rest, and in addition to an antidepressant effect, it also has calming effects.

How does it work? Mechanism of action of the drug

As we have indicated previously, trazodone is classified as SARI, having a somewhat special mechanism of action among the rest of antidepressants.

Trazodone acts at the serotonergic system level (like most antidepressants) in two specific ways.

In the first place, this substance produces a blockage of brain serotonin reuptake, in such a way that said neurotransmitter remains in the synaptic space for a longer time.

This supposes that it has an agonist effect on the synthesis and maintenance of serotonin at the brain level, it increases its levels (which are decreased during the depression and this is something that correlates with the decrease in the mood).

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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 first.

However, trazodone has a second effect that differentiates it from other drugs, and that seems contrary to the previous mechanism of action.

And it is also that it acts as an antagonist of serotonin 5-HT2A receptors, preventing or hindering these receptors from being activated.

This second aspect is what makes trazodone have a slightly different profile and effects than other antidepressants.

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Regarding its interaction with other neurotransmitter systems, it does not present great anticholinergic effects, something that has made this drug a better option than tricyclics (although the doses must also be regulated) in patients with cerebrovascular and cardiac pathology and dementias.

However, it must be taken into account that it can generate arrhythmias.

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It also has a minor effect on the adrenergic (blocking some receptors) and histaminergic systems, something that can lead to the generation of side effects.

Main indications

The main indication for trazodone is obviously, as an antidepressant that it is, major depression. Its effectiveness is also high in those depressions that appear together with anxiety symptoms.

Its clinical utility has also been observed in other disorders in which there are components of anxiety or that are based on it, such as generalized anxiety disorder, Obsessive-Compulsive Disorder, or bulimia.

In addition to this, it has also been observed to be useful for the treatment of substance addictions, being a good alternative for patients with withdrawal syndrome to benzodiazepines, and in the treatment of alcoholism (including the presence of delirium tremens).

Another of its indications is insomnia, which is effectively reduced by increasing sleep time without greatly affecting the deep sleep phase.

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

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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 the behavioral disorders of Alzheimer’s. although a greater amount of study is required regarding the latter.

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

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.

Secondary symptoms, sedation, and fatigue, the presence of headaches, nausea, and vomiting, gastric disturbances (diarrhea or constipation), appetite disturbances, sweating, tremors (which may lead to seizures in some cases), are common. ringing, numbness, and vision problems.

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In some cases, it can also cause chest and muscle pain, altered consciousness, breathing problems, and arrhythmias. Like other antidepressants, trazodone can also contribute to the genesis of suicidal ideation in the first moments of use.

Although, unlike other antidepressants, it does not seem to generate 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. alone and that cause pain to those who suffer from them (which may require urgent and even surgical treatment).

Although it is sometimes used in dementias and has a lower risk than tricyclics of generating heart problems, it requires a high degree of caution in its use and dosage carefully prescribed by the doctor, since it can generate arrhythmias.

It is contraindicated in patients who have just suffered a heart attack, as well as in those with liver or kidney disease.

Caution should be exercised in subjects with bipolarity because if the medication is not regulated, the consumption of trazodone can cause a shift from depressive to manic phase.

It is also contraindicated in people who have suffered from priapism or have Peyronie’s disease.

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Finally, it must be taken into account that trazodone can be excreted in breast milk and transmitted through the placenta so that pregnant and lactating women have contraindicated its use.

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