![]() ![]() Caregivers should be advised to closely observe the patient on a daily basis and to communicate immediately with the prescriber the emergence of agitation, irritability, unusual changes in behavior, or suicidality. Patients with depression or comorbid depression in the setting of other psychiatric illness being treated with antidepressants should be observed for clinical worsening and suicidality, especially during the initial few months of drug therapy, or at times of dose changes. Such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. Patients should be adequately screened for bipolar disorder prior to initiating any antidepressant. If a patient develops manic symptoms, trazodone should be withheld and appropriate therapy initiated to treat the manic symptoms. Likewise, complaints of insomnia in a depressed patient are common but could indicate the presence of a mixed episode in a patient with bipolar disorder. Treating such an episode with an antidepressant alone may increase the likelihood of precipitating a switch to mania or a hypomanic episode in patients with underlying bipolar disorder. Patients with bipolar disorder may initially present with symptoms of a major depressive episode. Findings from one large systematic review suggest there may be a small improvement in sleep quality during short-term use of low-dose trazodone however, additional studies are needed to determine long-term safety and efficacy. Antidepressants like trazodone may be considered for insomnia when there is a co-existing mood disorder and therapeutic antidepressant doses are used. ![]() placebo other studies were considered inadequate for assessment. The American Academy of Sleep Medicine (AASM) guidelines recommend against trazodone for chronic insomnia based on a short-term trial which evaluated trazodone 50 mg/night and found no clinically significant improvement in sleep outcomes and significantly more side effects (e.g., headache, daytime somnolence) vs. There is insufficient/limited evidence for efficacy of trazodone for chronic insomnia. Titration from a low initial dose (e.g., 25 to 50 mg) is recommended and may increase tolerability. A change to the treatment regimen or discontinuation of trazodone may be necessary in patients with emerging suicidality or worsening depression.ΔΆ5 mg to 150 mg PO at bedtime is the usual dose range. Caregivers and/or patients should immediately notify the prescriber of changes in behavior or suicidal ideation. All patients should be monitored for symptom worsening or suicidality, especially at treatment initiation or after dose changes. The need for an antidepressant in children, adolescents, or young adults for any use must be weighed against the risk of suicidality it is unknown if this risk extends to long-term use. The difference in absolute risk of suicidal thoughts and behaviors across different indications was highest in those with major depression. In a pooled analysis of placebo-controlled trials of antidepressants (n = 4,500 pediatrics and 77,000 adults), there was an increased risk for suicidal thoughts and behaviors in patients 24 years of age and younger receiving an antidepressant versus placebo, with considerable variation in the risk of suicidality among drugs. A boxed warning in the product label describes the risk of suicidality and suicidal ideation in children, adolescents, and young adult patients receiving antidepressants. Safety and efficacy of trazodone for the treatment of depression have not been established in pediatric patients less than 18 years of age. ![]()
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |