Trazodone Addition to Paroxetine and Mirtazapine in a Patient with Treatment-Resistant Depression: The Pros and Cons of Combining Three Antidepressants

[Serotonin neurotrasmission and treatment options for depression]

The efficacy of modern antidepressants is largely related to their ability to enhance neurotransmission of serotonin. The medicines with serotonergic properties include trazodone, which is intermediate between tricyclic antidepressants with their powerful antidepressive effect and selective serotonin reuptake inhibitors, as first-line agents in the treatment of depression and anxiety disorders. The value of trazodone for clinical practice is determined by the effective elimination of the symptoms of major depressive disorder in combination with good tolerability, including in elderly patients. Among the advantages of trazodone is the absence of such undesirable effects as sexual dysfunction and weight gain. Trazodone has significant hypnotic and anxiolytic properties, which gives it special meaning in the treatment of depression, combined with insomnia and anxiety. It is emphasized that the beneficial effect of trazodone on sleep should not prevent its main use as a drug for treating major depressive disorder regardless of whether depression is accompanied by insomnia or not.

Fan the flame: trazodone-induced mania in a unipolar depressed patient with stable sertraline treatment

Depressed patients often complain of sleep disturbance. Routine antidepressive strategies sometimes fail to deal with this intractable issue. Indeed, the supplementation of sleep promoting antidepressants (eg, trazodone, mirtazapine, and agomelatine) is prevalent in clinical practice. However, the combination of different antidepressants may increase the affective lability. Herein, we document a patient with unipolar depression who was compliant with sertraline treatment and who dramatically switched to mania after adding trazodone as a sleeping aid. This case extended our understanding of the potential manic-switching risk when trazodone is used to promote sleep.