Trazodone Did Better for Elderly Than Amitriptyline or Mianserin in DB: In a DB study of 104 elderly patients with Major Depressive Disorder, trazodone did significantly better. Clinical activity and tolerability of trazodone, mianserin, and amitriptyline in elderly subjects with major depression: a controlled multicenter trial. U Milan: Altamura AC, Mauri MC, Rudas N, Carpiniello B, Montanini R, Perini M, Scapicchio PL, Hadjchristos C, Carucci G, Minervini M, et al. Clin Neuropharmacol 1989;12 Suppl 1:S25-33; S34-7

Trazodone Didn't Do Quite as Well as Bupropion in DB: In a 6-week, 111-patient DB study of Major Depressive Disorder, bupropion at 225-450 mg/day was compared to trazodone at 150-450 mg/day. The 58% vs. 46% improvement favored bupropion but the difference was not significant. There was a 2.5 pound weight loss vs. 1.2 pound weight gain. Comparison of bupropion and trazodone for the treatment of major depression. Duke: Weisler RH, Johnston JA, Lineberry CG, Samara B, Branconnier RJ, Billow AA. J Clin Psychopharmacol 1994 Jun;14(3):170-9

Trazodone Did as Well as Fluoxetine in DB: In a DB 6-week study of Major Depressive Disorder, trazodone averaged 250 mg/day vs. fluoxetine 20 mg/day. There was no difference in the number discontinuing due to side-effects although the side-effects were different. Fluoxetine versus trazodone: efficacy and activating-sedating effects. Lilly. J Clin Psychiatry 1991 Jul;52(7):294-9, Beasley CM Jr, Dornseif BE, Pultz JA, Bosomworth JC, Sayler ME.

Trazodone Did as Well as Venlafaxine in DB: In a DB PC study of 225 patients with Major Depressive Disorder, 149 completed 6 week of treatment. Those 149 responders continued in blind 1 year follow-up. Both were better than placebo. Venlafaxine was better with cognitive disturbance and retardation and trazodone was better with sleep. Vine Street Clinic. A comparison of venlafaxine, trazodone, and placebo in major depression. Cunningham LA, Borison RL, Carman JS, Chouinard G, Crowder JE, Diamond BI, Fischer DE, Hearst E. J Clin Psychopharmacol 1994 Apr;14(2):99-106

Trazodone Did as Well or Better than Imipramine in Small 1 Year DB: In a 44-patient study of Major Depressive Disorder, trazodone did as well as imipramine with to 3 years of follow-up. Long-term therapy for depression with trazodone. Fabre LF Jr, Feighner JP. J Clin Psychiatry 1983 Jan;44(1):17-21

Trazodone Did as Well as Amitriptyline in DB: In a 202-patient DB PC study, trazodone did as well as amitriptyline. Trazodone in depressed outpatients. Rickels K, Case WG.

Amitriptyline Did better than Trazodone in Small DB: 43 Major Depressive Disorder patients. Trazodone and amitriptyline in treatment of depressed inpatients. A double-blind study. Moises HW, Kasper S, Beckmann H. Pharmacopsychiatria 1981 Sep;14(5):167-71

Trazodone Better than Mianserin in DB: In a 126-patient DB 6-week study of Major Depressive Disorder, trazodone 100-200 mg at bedtime vs. mianserin 60-120 mg at bedtime were compared. There were twice as many mianserin dropouts due to side effects. Benefit of HAM-D and Zung Anxiety were equal for those remaining in study. Trazodone and mianserin in general practice. Beaumont G, Gringras M, Ankier SI. Psychopathology 1984;17 Suppl 2:24-9

Trazodone At Bedtime at Good as Three Times a Day: In a DB study of trazodone 150 mg at bedtime vs. 50 mg. three times a day vs. placebo, there was no difference between the two trazodone groups and both had significant benefit. A comparison of two oral dosage regimens of 150 mg trazodone in the treatment of depression in general practice. Davey A. Psychopharmacology (Berl) 1988;95 Suppl:S25-30

Trazodone HS Up to 400mg Better Than TID: In a DB study of Major Depressive Disorder, equal improvement but better sleep occurred with all the medicine at bedtime.  There was less daytime dry mouth, headache, and daytime sleepiness with all the medicine at bedtime although it didn’t quite reach statistical significance. Trazodone--a comparison of single night-time and divided daily dosage regimens. Brooks D, Prothero W, Bouras N, Bridges PK, Jarman CM, Ankier SI. Psychopharmacology (Berl) 1984;84(1):1-4

Trazodone = Amitriptyline and No Wt Gain: In a 270-patient 6-week DB study of Major Depressive Disorder, amitriptyline up to 200/day caused weight gain while trazodone up to 400/day caused slightly weight loss in overweight group and apparently no net change in ideal weight group. Both medications did equally well at decreasing depression. Weight changes in antidepressants: a comparison of amitriptyline and trazodone. Hecht Orzack M, Cole JO, Friedman L, Bird M, McEachern J. Neuropsychobiology. 1986;15 Suppl 1:28-30

Trazodone 150 Did Better than Trazodone 75 in Elderly: DB 6 week 20 elderly MDD. Differential dosing of trazodone in elderly depressed patients: a study to investigate optimal dosing. Mukherjee PK, Davey A. J Int Med Res 1986;14(5):279-84

Anxiety Helped by Trazodone or Imipramine Better than with Benzodiazepine: In a 230-patient DB PC 8-week study of generalized anxiety disorder, diazepam (Valium) patients (average dose 26 mg) improved the quickest.  However, by the third week, imipramine (average dose 143 mg) and trazodone (255 mg) were catching up.  Among completers, moderate to marked improvement was reported by 73% of patients treated with imipramine, 69% of patients treated with trazodone, 66% of patients treated with diazepam, but only 47% of patients treated with placebo.  While the antidepressants caused more side-effects, drop-out rates were equal. A placebo-controlled comparison of imipramine, trazodone, and diazepam. Rickels K, Downing R, Schweizer E, Hassman H. University of Pennsylvania. Arch Gen Psychiatry. 1993 Nov;50(11):884-95

Trazodone Fewer Cardiac Effects Than Amitriptyline: No quinidine-like effects and only minor effects of heart rate, BP, and t waves. A double-blind non-crossover placebo-controlled study between group comparison of trazodone and amitriptyline on cardiovascular function in major depressive disorder. van de Merwe TJ, Silverstone T, Ankier SI, Warrington SJ, Turner P. Psychopathology 1984;17 Suppl 2:64-76

Trazodone Safe for Cardiac Patients: (1) Trazodone has little effect on cardiac conduction. (2) Trazodone does not worsen supraventricular arrhythmias. (3) Trazodone produces less postural hypotension than most other antidepressants and it tends to lower heart rate. (4) Lower doses of trazodone (100-300 mg) are better tolerated and more effective in major depressives simultaneously debilitated by significant cardiovascular disease. (5) It is possible that the so-called 'trazodone aggravation' of ventricular irritability is a statistical artifact. The role of trazodone in the treatment of depressed cardiac patients. Himmelhoch JM, Schechtman K, Auchenbach R. Psychopathology 1984;17 Suppl 2:51-63

Trazodone No ECG Effect in Elderly: ECG findings in geriatric depressives given trazodone, placebo, or imipramine. Hayes RL, Gerner RH, Fairbanks L, Moran M, Waltuch L. J Clin Psychiatry 1983 May;44(5):180-3

Nefazodone is a potent inhibitor of CYP3A4 and is therefore absolutely contraindicated with concurrent administration of terfenadine, astemizole, and cisapride.

Lower Trazodone with Ketoconazole, Ritonavir, or Indinavir: Substantial increases in trazodone hydrochloride (Desyrel) plasma concentration may occur with concurrent dosing of the cytochrome P450 3A4 (CYP3A4) inhibitors ketoconazole, ritonavir, and indinavir, according the FDA. Adverse effects include nausea, hypotension, and syncope.  The dose of trazodone should be lowered.

Priapism Treated with Epinephrine: Seventeen out of the 19 prolonged erections were due to intracavernosal vasoactive agent injection and the remaining two were idiopathic. In all cases 2 ml adrenalin (1/100 000) was injected in each cavernosal body. In the patients who did not respond to the first injection, repeated adrenalin injections were performed at 20 min intervals. Blood pressure and heart rate were monitored during the injections. Detumescence was achieved in ten (53%) patients after the first injection. Repeated adrenalin injections (2-5 injections) were required in nine patients and eight (42%) of them achieved detumescence. Only one (5%) patient who had 26-h prolonged erection could not achieve detumescence. Intracavernosal adrenalin injection in priapism. Keskin D, Cal C, Delibas M, Ozyurt C, Gunaydin G, Nazli O, Cureklibatir I. Int J Impot Res 2000 Dec;12(6):312-4; Also: 18 consecutive cases of priapism treated with intracorporeal irrigations of dilute epinephrine solution. Of the 18 patients 16 were treated successfully. The 2 failures had priapism 36 hours and 5 days in duration. U Miami, Diluted epinephrine solution for the treatment of priapism. Molina L, Bejany D, Lynne CM, Politano VA. J Urol 1989 May;141(5):1127-8

Priapism Treated with Methylene Blue: Worked in 67% of cases including both from trazodone. Given intracavernous. U Virginia. Alternative approaches to the management of priapism. deHoll JD, Shin PA, Angle JF, Steers WD. Int J Impot Res 1998 Mar;10(1):11-4; Also: 25 patients were treated for priapism. Etiologies were: 22 drug-mediated (PGE1 or papaverine/phentolamine mixture) after corpus cavernosum injection therapy (CCIT), 1 leukemia-induced and 2 idiopathic high-flow priapism. Patient ages ranged from 13 to 72 years. The average duration of priapism was 5 hours and 22 minutes after CCIT. MB was administered after blood aspiration of the corpora cavernosa. 5 ml of MB was injected intracavernously (i.c.) and left for 5 min. MB was then aspirated and the penis compressed for an additional 5 min. All patients with CCIT-induced priapism were cured with MB alone. The 3 patients who did not respond to MB underwent i.c. phenylephrine administration and finally, if necessary, embolization of the pudendal artery. Etiology and duration of priapism were the strongest predictors for success with intracavernously administered MB. The primary side effects were a transient burning sensation and blue discoloration of the penis on injection of MB. The initial baseline erectile status was restored in all patients cured by MB. MB demonstrates distinct advantages over a-adrenergic agents for intracavernous use, such as lower costs, absence of systemic or local toxic side effects and shorter treatment time leading to faster detumescence. Methylene blue: an effective therapeutic alternative for priapism induced by intracavernous injection of vasoactive agents. U Kiel, Martinez Portillo FJ, Fernandez Arancibia MI, Bach S, Alken P, Junemann KP. Arch Esp Urol 2002 Apr;55(3):303-8.

172 Cases Priapism Treated Without Surgery: treated or submitted to self medication with alpha-agonist agents (eprephrine, phenylephrine or etilefrine) with an eventual drainage of the corporae. All episodes have disappeared and sexual function was preserved. A conservative treatment of priapism has been designed using corporal drainage and intracavernous etilefrine for acute priapism; as well as preventive treatment for those of the patients exposed to sickle cell disease to avoid surgery and its frequent fibrotic sequelae, leading to impotence in 50% of the cases. Ambulatory treatment and prevention of priapism using alpha-agonists. Apropos of 172 cases. Virag R, Bachir D, Floresco J, Galacteros F, Dufour B. Chirurgie 1997 Jan;121(9-10):648-52

Undetected Trazodone Priapism May be Common (12%): Of 74 VA PTSD patients surveyed, 60 patients were able to maintain an effective dose of trazodone. The other 14 patients were unable to tolerate the medication. Seventy-two percent of the 60 patients assessed found trazodone helpful in decreasing nightmares, from an average of 3.3 to 1.3 nights per week (p<.005). Ninety-two percent found it helped with sleep onset, and 78% reported improvement with sleep maintenance. There was a significant correlation between the effectiveness in decreasing nightmares and improving sleep (r= .57, p < .005). The effective dose range of trazodone for 70% of patients was 50 to 200 mg nightly. Of the 74 patients surveyed, 9 (12%) reported priapism. U Michigan. Survey on the usefulness of trazodone in patients with PTSD with insomnia or nightmares. Warner MD, Dorn MR, Peabody CA.

Clitoral Priapism: Individual cases reported with trazodone (Obstet Gynecol 2002 Nov;100(5 Pt 2):1089-91) and nefazodone (Int Clin Psychopharmacol 1999 Jul;14(4):257-8) which also noted reports with fluoxetine and bromocriptine.

SSRI Priapism: Case reported with citalopram (Pharmacotherapy 2002 Apr;22(4):538-41) & paroxetine (Ann Med Psychol (Paris) 1996 May;154(2):145-6; discussion 146-7) & hydroxyzine (Neuropsychobiology 1994;30(1):4-6) which has a metabolite with some resemblance to trazodone.