Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Trazodone is an oral antidepressant drug that
affects the chemical messengers (neurotransmitters) within the brain that nerves
use to communicate with (stimulate) each other. The major neurotransmitters are
acetylcholine, norepinephrine, dopamine and serotonin. Many experts believe that
an imbalance among the different neurotransmitters is the cause of depression. Although
the exact mechanism of action of trazodone is unknown, it probably improves
symptoms of depression by inhibiting the uptake of serotonin by nerves in
the brain. This results in more serotonin to stimulate other nerves. Trazodone
also may increase directly the action of serotonin. Trazodone is chemically
unrelated to the selective serotonin reuptake inhibitors (SSRIs), the tricyclic
antidepressants (TCAs) or the monoamine oxidase inhibitors (MAO inhibitors). It
is chemically related to nefazodone (Serzone) and shares its actions. Trazodone
was approved by the FDA in 1982.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 50, 100, 150, and 300 mg
STORAGE: Store at room temperature, 15-30°C (59-86°F)
PRESCRIBED FOR: Trazodone is primarily used for the treatment of depression.
It is sometimes prescribed as a sedative, and it also is used in combination
with other drugs for the treatment of panic attacks, aggressive behavior,
agoraphobia, and cocaine withdrawal.
DOSING: For the treatment of depression, the dose for adults is 150-600 mg
per day. The initial starting dose usually is 150 mg per day. Trazodone is given
in one or more daily doses, sometimes with the largest dose at night. As with
all antidepressants, it may take several weeks for the full effects of treatment
to be seen. Doses often are adjusted slowly upwards to find the optimal dose.
Elderly patients and debilitated persons may need lower doses. Trazodone should
be taken after a meal or light snack to reduce the risk of dizziness. Food also
increases the amount of drug absorbed into the body. Doses of 25-75 mg are
prescribed for insomnia.
DRUG INTERACTIONS: All antidepressants that increase concentrations of
serotonin in the brain, including trazodone, should not be taken with
MAO-inhibitors. Drugs in the MAO-inhibitor class include isocarboxazid
(Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and
procarbazine
(Matulane). Such combinations may lead to confusion,
high blood pressure and
tremor. This same type of interaction may occur when trazodone is used with
selegiline (Eldepryl). If a patient is switched from trazodone to an MAO
inhibitor, at least one week should be allowed after stopping trazodone before
the MAO inhibitor is begun. After stopping an MAO inhibitor, two weeks should
elapse before starting trazodone.
Increased blood concentrations of digoxin and phenytoin (Dilantin) have been
reported in persons taking trazodone due to a decrease in the metabolism
(break-down and elimination) of these drugs by trazodone.
Carbamazepine (Tegretol) may decrease blood levels of trazodone by increasing its
elimination from the body. Ketoconazole
(Nizoral), ritonavir
(Norvir), and indinavir
(Crixivan) inhibit the
breakdown of trazodone leading to increased blood levels of trazodone and
potential side effects.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Post-traumatic stress disorder (PTSD), a psychiatric condition, can develop after any catastrophic life event. Symptoms include nightmares, flashbacks, sweating, rapid heart rate, detachment, amnesia, sleep problems, irritability, and exaggerated startle response. Treatment may involve psychotherapy, group support, and medication.
Insomnia is the perception or complaint of inadequate or poor-quality sleep because of difficulty falling asleep; waking up frequently during the night with difficulty returning to sleep; waking up too early in the morning; or unrefreshing sleep. Secondary insomnia is the most common type of insomnia. Treatment for insomnia include lifestyle changes, cognitive behavioral therapy, and medication.
Dysthymia is a less severe form of chronic depression. Symptoms and signs include insomnia, suicidal thoughts, guilt, empty feeling, loss of energy, helplessness, sluggishness, and persistent aches and pains. Treatment may involve psychotherapy, electroconvulsive therapy, and antidepressants.
Sleepwalking is a condition in which an individual walks or does other activities while asleep. Factors associated with sleepwalking include genetic, environmental, and physiological. Episodes of sleepwalking may include quiet walking to agitated running. Conditions that may have similar symptoms of sleepwalking, but are not include night terrors, confusional arousals, and nocturnal seizures. Treatment of sleepwalking generally include preventative measures. Medication may be prescribed if necessary.
Postpartum depression is a form of depression that occurs within a year after delivery. It is thought that rapid hormone changes after childbirth may lead to depression. Symptoms of postpartum depression include crying a lot, headaches, chest pains, eating too little or too much, sleeping too little or too much, withdrawal from friends and family, and feeling irritable, sad, hopeless, worthless, guilty, and overwhelmed. Treatment typically involves talk therapy and medication.
Nightmares are dreams that cause high anxiety or terror. Nightmares may be a part of posttraumatic stress disorder (PTSD), and they usually occur during rapid eye movement (REM) sleep. There are several different treatment options for nightmares, including cognitive-behavioral therapy and medications.
Sleepwalking is a disorder characterized by walking or other activities while
seemingly still asleep.
What are the causes, incidence, and risk factors of sleepwalking?
Sleepwalking has been described in medical literature dating before
Hippocrates (460 BC-370 BC). In Shakespeare's tragic play, Macbeth, Lady
Macbeth's famous sleepwalking scene ("out, damned spot") is ascribed to her
guilt and resulting insanity as a consequence of her involvement in the murder
of her father-in-law.
Sleepwalking is characterized by a complex behavior (walking) occurring while
asleep. Occasionally nonsensical talking may occur. The person's eyes are
commonly open, but have a characteristic glassy "look right through you"
character. This activity most commonly occurs during middle childhood and young
adolescence. Approximately 15% of children between 4-12 years of age will
experience sleepwal...
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