Management of Depression

The authors of the letter express interest in a review on managing depression by Dr Simon and colleagues, appreciating the comprehensive view and attention to nonpharmacological treatment. However, they note the absence of trazodone among the listed antidepressants, possibly due to search criteria. Trazodone is a US Food and Drug Administration-approved antidepressant used to treat sleep disorders, anxiety, and behavioral symptoms of dementia at low doses. The medication works through a complex central mechanism, increasing noradrenaline release and serotonin reuptake inhibition. Trazodone is primarily an antidepressant at dosages up to 300 mg/d and lacks anticholinergic effects, does not cause or worsen parkinsonism, and does not affect libido. However, it can cause hypotension and dizziness as adverse effects. Trazodone serum levels may vary due to genetic P-glycoprotein polymorphisms, but it does not affect liver cytochromes, resulting in minimal drug interactions. The authors believe trazodone is a useful antidepressant in geriatric medicine due to its lack of interactions and the prevalence of sleep problems and anxiety in elderly patients. They suggest that a review on depression treatment should include trazodone to provide complete information on available pharmacological choices. The inclusion of trazodone would provide readers with a more comprehensive understanding of antidepressant options.