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DOI: 10.1055/a-2600-3773
Trazodon in der gerontopsychiatrischen Versorgung
Trazodone in psychogeriatric care
Zusammenfassung
Trazodon ist ein dualserotonerges Antidepressivum mit vernachlässigbaren anticholinergischen Effekten, das in niedrigen Dosierungen sedierend, hypnotisch und anxiolytisch und in höheren Dosierungen antidepressiv wirkt. Die Verträglichkeit ist gut und die wichtigsten unerwünschten Arzneimittelwirkungen sind orthostatische Hypotonie und Benommenheit/Sedierung mit erhöhtem Sturzrisiko, dosisabhängige moderate Erhöhung der QTc-Zeit mit dem Risiko für ventrikuläre Herzrhythmusstörungen und Priapismus. Trazodon weist evidenzbasierte antidepressive Wirksamkeit bei älteren kognitiv unauffälligen Menschen auf und es gibt Hinweise, dass Trazodon auch bei Menschen mit Depression und komorbider Demenz/kognitiver Dysfunktion antidepressiv wirksam ist. Bei Menschen mit Demenz und Schlafstörungen verbessert Trazodon die Schlafeffizienz und verlängert die nächtliche Schlafdauer. Zwar existieren Hinweise auf eine Wirksamkeit von Trazodon zur Behandlung von psychischen und Verhaltenssymptomen bei Demenz (v. a. Agitation) und wird Trazodon ausdrücklich zur Behandlung von motorischer Unruhe bei frontotemporaler Demenz empfohlen. Die Evidenz dafür ist aber eher schwach. Auf der Basis von Tierversuchen ergeben sich Hinweise auf neuroprotektive Effekte von Trazodon durch Hemmung der für einige neurodegenerative Erkrankungen typischen Überaktivierung der „unfolded protein response“ (UPR). Zudem konnte gezeigt werden, dass die regelmäßige Anwendung von Trazodon die Verschlechterung der kognitiven Funktion bei Patienten mit der Diagnose einer Demenz vom Alzheimer-Typ verzögert. Gegenwärtig ist jedoch noch unklar, ob Trazodon signifikante neuroprotektive Effekte beim Menschen aufweist.
Abstract
Trazodone is a dual serotonergic antidepressant with insignificant anticholinergic effects. It features sedative, hypnotic and anxiolytic effects in lower and antidepressive effects in higher doses. Its tolerability is good and the most important adverse drug reactions are orthostatic hypotension, drowsiness/sedation with increased risk of falls, dose-dependent moderate QTc prolongation with the risk of ventricular arrhythmias and priapism. Trazodone has evidence-based efficacy in elderly patients with depression and normal cognitive functioning, and there is evidence of antidepressive efficacy of trazodone also in patients with depression and dementia/cognitive dysfunction. In patients with dementia and sleep disturbances, trazodone improves sleep efficiency and increases total nocturnal sleep time. Although there is some evidence of efficacy of trazodone in the treatment of behavioral and psychological symptoms of dementia, particularly agitation, and trazodone is explicitly recommended for treatment of motor unrest in frontotemporal dementia, the evidence for this is rather weak. Results from studies in animal models indicate neuroprotective effects of trazodone by inhibition of overactivation of signalling in the unfolded protein response (UPR) which is typical of some neurodegenrative diseases. It was demonstrated that regular trazodone use is associated with delayed cognitive decline in humans with a diagnosis of Alzheimer’s dementia. However, it is currently unclear if trazodone features significant neuroprotective effects in humans.
Publication History
Received: 18 December 2024
Accepted after revision: 29 April 2025
Article published online:
23 June 2025
© 2025. Thieme. All rights reserved.
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