Adjunctive Trazodone and Depression Outcome in Adolescents Treated with Serotonin Re-uptake Inhibitors

Recent published evidence suggests that adjunctive trazodone treatment may limit serotonin reuptake inhibitor (SRI) response in depressed adolescents in the context of a controlled trial. This study examined the effects of adjunctive trazodone on depression outcome in adolescents in a naturalistic treatment environment.

We conducted a cohort study through chart review of a clinical sample. Patients in our sample were 15 to 18 years of age treated with either a selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor. The treatment took place in the setting of a partial hospitalization program at a tertiary care centre from 2009-2014. The main outcome measure was the change in Beck Depression Inventory II (BDI-II) score from admission to discharge. We compared this outcome in patients who were exposed to adjunctive trazodone treatment compared to adolescents who did not receive trazodone in the final four weeks of the program.

Exposure to trazodone was significantly associated with non-response to treatment in our sample (n= 35; β₁= -7.76; 95% CI -0.52 to - 15.0; p<0.05; R² = 0.13). In exploring potential confounders, higher baseline BDI-II scores appeared to predict greater change in BDI-II scores from pre- to post-treatment.

In keeping with previous research, we found that trazodone exposure was associated with treatment non-response in adolescents taking SRIs. The findings should be interpreted cautiously since they are limited by small sample size. Future randomized controlled trials of trazodone in samples of adolescents taking SRIs for depression are warranted.