[Trazodone in psychogeriatric care]

Trazodone is a dual serotonergic antidepressant with insignificant anticholinergic effects. It features sedative, hypnotic and anxiolytic effects in lower and antidepressive effects in higher doses. Its tolerability is good and the most important adverse drug reactions are orthostatic hypotension, drowsiness/sedation with increased risk of falls, dose-dependent moderate QTc prolongation with the risk of ventricular arrhythmias and priapism. Trazodone has evidence-based efficacy in elderly patients with depression and normal cognitive functioning, and there is evidence of antidepressive efficacy of trazodone also in patients with depression and dementia/cognitive dysfunction. In patients with dementia and sleep disturbances, trazodone improves sleep efficiency and increases total nocturnal sleep time. Although there is some evidence of efficacy of trazodone in the treatment of behavioral and psychological symptoms of dementia, particularly agitation, and trazodone is explicitly recommended for treatment of motor unrest in frontotemporal dementia, the evidence for this is rather weak. Results from studies in animal models indicate neuroprotective effects of trazodone by inhibition of overactivation of signalling in the unfolded protein response (UPR) which is typical of some neurodegenrative diseases. It was demonstrated that regular trazodone use is associated with delayed cognitive decline in humans with a diagnosis of Alzheimer's dementia. However, it is currently unclear if trazodone features significant neuroprotective effects in humans.