eMedExpert Home > Compare Drugs > Trazodone (Desyrel)

• Efficacy: Both medications are similarly effective for major depression. Fluoxetine appears to have a slower onset of antidepressant action than does trazodone 1, 3, 5.
• Side effects and tolerability: Fluoxetine has a higher rate of rhinitis and tremor, while trazodone has higher incidence of somnolence and dizziness. More combined events suggesting activation (agitation, anxiety, nervousness, insomnia) occur with fluoxetine than with trazodone, while more combined events suggesting sedation (somnolence, asthenia) occur with trazodone than with fluoxetine 1. Also fluoxetine is associated more frequently with weight loss than trazodone 3.

• Efficacy: In the study alcohol-dependent outpatients with persisting insomnia were treated with either gabapentin or trazodone. Both medications were effective on the Sleep Problems Questionnaire but the gabapentin group improved significantly more than the trazodone group 2.
• Side effects and tolerability: Most common adverse drug reactions with trazodone are drowsiness, dizziness and dry mouth.

• Efficacy:
  Major depressive disorder: Trazodone and paroxetine are equally effective at reducing symptoms of depression and promoting remission. Onset of efficacy is slightly faster with paroxetine treatment. Trazodone may be of advantage in depressed patients with sleep difficulties 4.
• Side effects: Adverse drug reactions with trazodone are mainly of the nervous system, and with paroxetine mainly gastrointestinal 4.

• Efficacy:
  Depression: Trazodone and imipramine are of approximately equivalent efficacy. Some evidence suggests that trazodone may have an earlier anxiolytic effect than imipramine by day 4 and a greater antidepressant effect by day 22 of treatment in severe endogenous depression 14.
• Side effects: Anticholinergic side effects are significantly less apparent on trazodone compared to imipramine. Impaired visual accommodation is significantly greater with imipramine treatment 14.

• Efficacy:
  Major depressive disorder: The study showed that trazodone and sertraline are equally effective in reducing depressive symptoms and promoting remission, and have similar onset times. Trazodone may be a therapeutic option in the treatment of patients with major depression showing prevalent sleep disturbances 6.
• Side effects: Tolerability profiles reflected the differing pharmacological properties of two antidepressants. In the comparative study adverse drug reactions, mostly of mild intensity, were reported in 42% of trazodone-treated patients (mainly of the nervous system) and 43% of sertraline-treated patients (mainly gastrointestinal) 6.

• Efficacy:
  Major depressive disorder: Trazodone and amitriptyline are both effective but not statistically different from each other in terms of antidepressant action 8.
• Neurotic depression: Trazodone is superior to amitriptyline in the treatment of neurotic depression. Significant improvement may be noted with trazodone within the first seven days of therapy 15.
• Side effects: Amitriptyline produces significantly higher weight gains than trazodone 7. Amitriptyline has the effects on the electrocardiograph and on systolic time intervals consistent with its proven anticholinergic and quinidine-like properties. Trazodone, in contrast, has no quinidine-like effects and minor effects on systolic time intervals 10.

• Efficacy:
  Depression: In a double-blind clinical trial of outpatients with moderate to severe major depression the overall efficacy for both drugs was similar. Improvement in the trazodone treatment group was significantly greater on day 7 because of the effects on sleep. At the end of treatment, 58% of the bupropion-treated patients and 46% of the trazodone-treated patients were considered much or very much improved 9.
• Side effects: Anorexia and anxiety are reported significantly more often for the bupropion, whereas somnolence, appetite increase, and edema are reported significantly more often for the trazodone 9.

• Efficacy:
  Major depressive disorder: Venlafaxine can produce more improvement in the cognitive disturbance and retardation factors on the Hamilton Rating Scale for Depression. Trazodone is more effective against the sleep disturbance factor 11. Trazodone efficiency in comparison to venlafaxine is faster, so trazodone is characterized by potentially quicker beginning of activity in patients with depression disorders 12.
• Side effects: Venlafaxine is most likely to cause nausea, whereas trazodone is associated with the most dizziness and somnolence 11. Libido decrease is common side effect with venlafaxine treatment 12.

• Efficacy:
  Major depressive disorder: Mirtazapine has significant clinical advantages over trazodone in terms of overall efficacy and tolerability 13.
• Side effects: Somnolence is reported significantly more often with trazodone 13.

• Trazodone (Desyrel) Medical Facts

• 1. Beasley CM Jr, Dornseif BE, Pultz JA, Bosomworth JC, Sayler ME Fluoxetine versus trazodone: efficacy and activating-sedating effects. J Clin Psychiatry. 1991 Jul;52(7):294-9. PubMed
• 2. Karam-Hage M, Brower KJ. Open pilot study of gabapentin versus trazodone to treat insomnia in alcoholic outpatients. Psychiatry Clin Neurosci. 2003 Oct;57(5):542-4. PubMed
• 3. Debus JR, Rush AJ, Himmel C, Tyler D, Polatin P, Weissenburger J. Fluoxetine versus trazodone in the treatment of outpatients with major depression. J Clin Psychiatry. 1988 Nov;49(11):422-6. PubMed
• 4. Kasper S, Olivieri L, Di Loreto G, Dionisio P. A comparative, randomised, double-blind study of trazodone prolonged-release and paroxetine in the treatment of patients with major depressive disorder. Curr Med Res Opin. 2005 Aug;21(8):1139-46. PubMed
• 5. Perry PJ, Garvey MJ, Kelly MW, Cook BL, Dunner FJ, Winokur G. A comparative trial of fluoxetine versus trazodone in outpatients with major depression. J Clin Psychiatry. 1989 Aug;50(8):290-4. PubMed
• 6. Munizza C, Olivieri L, Di Loreto G, Dionisio P. A comparative, randomized, double-blind study of trazodone prolonged-release and sertraline in the treatment of major depressive disorder. Curr Med Res Opin. 2006 Sep;22(9):1703-13. PubMed
• 7. Hecht Orzack M, Cole JO, Friedman L, Bird M, McEachern J. Weight changes in antidepressants: a comparison of amitriptyline and trazodone. Neuropsychobiology. 1986;15 Suppl 1:28-30. PubMed
• 8. Kerr TA, McClelland HA, Stephens DA, Ankier SI. Trazodone. A comparative clinical and predictive study. Acta Psychiatr Scand. 1984 Dec;70(6):573-7. PubMed
• 9. Weisler RH, Johnston JA, Lineberry CG, Samara B, Branconnier RJ, Billow AA. Comparison of bupropion and trazodone for the treatment of major depression. J Clin Psychopharmacol. 1994 Jun;14(3):170-9. PubMed
• 10. van de Merwe TJ, Silverstone T, Ankier SI, Warrington SJ, Turner P. A double-blind non-crossover placebo-controlled study between group comparison of trazodone and amitriptyline on cardiovascular function in major depressive disorder. Psychopathology. 1984;17 Suppl 2:64-76. PubMed
• 11. Cunningham LA, Borison RL, Carman JS, Chouinard G, Crowder JE, Diamond BI, Fischer DE, Hearst E. A comparison of venlafaxine, trazodone, and placebo in major depression. J Clin Psychopharmacol. 1994 Apr;14(2):99-106. PubMed
• 12. Florkowski A, Gruszczynski W, Galecki P, Zboralski K, Kolodziejska I, Mikolajczyk I. Trazodone and venlafaxine in treatment of depressive disorders. Pol Merkur Lekarski. 2005 May;18(107):556-9. PubMed
• 13. van Moffaert M, de Wilde J, Vereecken A, Dierick M, Evrard JL, Wilmotte J, Mendlewicz J. Mirtazapine is more effective than trazodone: a double-blind controlled study in hospitalized patients with major depression. Int Clin Psychopharmacol. 1995 Mar;10(1):3-9. PubMed
• 14. Al-Yassiri MM, Ankier SI, Bridges PK. A double blind comparison of the efficacy and safety of trazodone and imipramine in endogenous depression. J Affect Disord. 1983 Nov;5(4):333-40. PubMed
• 15. Goldberg HL, Finnerty RJ. Trazodone in the treatment of neurotic depression. J Clin Psychiatry. 1980 Dec;41(12 Pt 1):430-4. PubMed

Published: March 31, 2008
Last updated: January 09, 2010