Trazodone has a hidden risk that can make some patients more depressed. This isn't about bipolar disorder or antidepressant-induced mania. It's about a metabolite, says Chris Aiken, MD. Dr Aiken is Instructor in Clinical Psychiatry at the Wake Forest University School of Medicine and the Director of the Mood Treatment Center in Winston-Salem, NC. He is Editor in Chief of The Carlat Psychiatry Report and Bipolar Disorder Section Co-Editor for Psychiatric Times.
Adolescents who take trazodone for sleep while on a serotonergic antidepressant are six times less likely to respond to the antidepressant and three times more likely to self harm. That was the case in a large, controlled trial of treatment-resistant depression. Hypnotic use was not controlled in that study, but the problems were not seen with other sleep medicines, and the finding was later confirmed in a naturalistic sample by a separate group. Listen to the full podcast for more.
For the full discussion, see How Trazodone Can Cause Depression.