Depression is a serious mood disorder. It can affect the way you feel, act, and think. Depression is a common problem among older adults, but clinical depression is not a normal part of aging. In fact, studies show that most older adults feel satisfied with their lives, despite having more illnesses or physical problems than younger people. However, if you’ve experienced depression as a younger person, you may be more likely to have depression as an older adult.
As you age, even though you may have taken a medication for decades, your body may react differently to it later in life. One reason for this is that your metabolism has slowed down. Some medicines need to be processed by your liver to benefit your health; slower digestion and liver function mean it may take longer for a drug to get into your bloodstream. Later, remnants of the medicine need to be eliminated from your body by the liver and kidneys. Slowdowns at this stage mean it may take longer for a drug to leave your body, so its effect lasts longer.
Studies also show that certain medications are less safe for older people, and it is important that you work with your provider or pharmacist to use medications that are safe for your age. The American Geriatrics Society’s Beers Criteria lists medications that may not be safe in older people and can be used as a tool when you talk with your provider or pharmacist about using safe medications.
What is trazodone?
Trazodone was developed in Italy in the 1960s as an antidepressant medication. Due to negative side effects associated with the drug early on—including dizziness, fainting, irregular heartbeat (and in rare cases, priapism in men)—the antidepressant wasn’t widely favored in the medical community. Eventually, however, internists and clinicians recognized the potential benefits of the drug, particularly when administered at low doses. In 1981, trazodone (the generic name of the pharmaceutical) was approved by the U.S. Food and Drug Administration (FDA) under the brand name Desyrel for use in treating major depressive disorder. Today, the medication is prescribed under the brand name Oleptro to treat sleep disorders such as insomnia as well as anxiety disorder and unipolar depression.
How should I take trazodone?
Trazodone comes as a tablet to take by mouth. The tablet is usually taken with a meal or light snack two or more times a day. To help you remember to take trazodone, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take trazodone exactly as directed. Do not take more or less of it, take it more often, or take it for a longer time than prescribed by your doctor.
Swallow the tablets whole or broken in half on the score mark.
Your doctor may start you on a low dose of trazodone and gradually increase your dose, not more than once every 3 to 4 days. Your doctor may decrease your dose once your condition is controlled.
Trazodone controls depression, but does not cure it. It may take 2 weeks or longer before you feel the full benefit of trazodone. Continue to take trazodone even if you feel well.
Do not stop taking trazodone without talking to your doctor. If you suddenly stop taking trazodone, you may experience withdrawal symptoms such as dizziness; nausea; headache; confusion; anxiety; agitation; difficulty falling asleep or staying asleep; extreme tiredness; seizures; pain, burning, or tingling in the hands or feet; frenzied or abnormally excited mood; ringing in the ears, or sweating. Your doctor will probably decrease your dose gradually.
Trazodone Side Effects In The Elderly
Trazodone is clinically useful in elderly patients, including people with agitated behavior, because of its specific anxiolytic and sleep normalizing effect and excellent safety and tolerability. In elderly patients, a very low starting dose is recommended, usually, no more than 25-50 mg/day for the I.R. However, older people may have more trazodone in their bodies over a longer period. And this may increase their risk for side effects, such:
- changes in appetite or weight
- dizziness or lightheadedness
- dry mouth
- muscle pain
- sexual problems in females; decreased sex drive, delayed orgasm, or unable to have an orgasm
- sexual problems in males; decreased sex drive, inability to get or keep an erection, or delayed or absent ejaculation
- stuffy nose
- tired, red, or itchy eyes
- uncontrollable shaking of a part of the body
- weakness or tiredness
Older adults may be more sensitive to the side effects of this drug, especially drowsiness, dizziness, and QT prolongation. Older patients need to watch out for serious side effects like
- chest pain
- fast, pounding, or irregular heartbeat
- loss of consciousness (coma)
- fever, sweating, confusion, fast or irregular heartbeat, and severe muscle stiffness or twitching, agitation, hallucinations, loss of coordination, nausea, vomiting, or diarrhea
- shortness of breath
- unusual bruising or bleeding
- small red or purple dots on the skin
- erection lasting more than 6 hours
- problems with thinking, concentration, or memory
- problems with coordination
Trazodone can cause painful, long-lasting erections in males. In some cases emergency and/or surgical treatment has been required and, in some of these cases, permanent damage has occurred. Talk to your doctor about the risk of taking trazodone.
Trazodone may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).
FDA Warning About Trazodone
Like many antidepressants, trazodone has been issued a “Black Box Warning” by the FDA. Taking trazodone has increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients. People taking this medication should be closely monitored for worsening symptoms and emergence of suicidal thoughts and behaviors. Trazodone is not approved for use in pediatric patients