Fabre L F
Fabre Clinic, Houston, TX 77004.
J Clin Psychiatry. 1990 Sep;51 Suppl:23-6.
Efficacy being constant, antidepressant choice is dictated by side effect profile, patient acceptance, and safety. Trazodone has been shown to be safe in overdose, and the side effect profile is mild, with sedation the most common side effect. Sleep electroencephalogram and clinical studies have shown trazodone effective in improving sleep in normal subjects, insomniac patients, and patients with major depression. Tolerance and rapid eye movement rebound on discontinuation do not occur. The 3- to 9-hour half-life of trazodone and its pharmacokinetics favors a dose weighted at bedtime. Studies comparing multiple daytime dosing to single dosing at bedtime have shown equal efficacy in relieving depression. At treatment onset, a single nighttime dose is more productive of sleep with less daytime drowsiness. These differences between single nighttime dosing and multiple daily dosing disappear with continued administration. Geriatric patients respond similarly. Trazodone is best dosed at 150 mg given predominantly (but not necessarily all) at bedtime and increased as needed to 200 to 300 mg for full antidepressant efficacy.
在疗效恒定的情况下，抗抑郁药的选择取决于副作用特征、患者接受度和安全性。曲唑酮已被证明在过量服用时是安全的，其副作用较轻，最常见的副作用是镇静。睡眠脑电图和临床研究表明，曲唑酮对改善正常受试者、失眠患者和重度抑郁症患者的睡眠有效。不会出现耐受性和停药时的快速眼动反跳。曲唑酮3至9小时的半衰期及其药代动力学特性有利于在睡前给予一次剂量。比较多次日间给药与睡前单次给药的研究表明，在缓解抑郁方面疗效相同。在治疗开始时，单次夜间剂量能产生更多睡眠且白天嗜睡较少。随着持续给药，单次夜间给药和每日多次给药之间的这些差异会消失。老年患者的反应类似。曲唑酮最佳剂量为150毫克，主要（但不一定全部）在睡前服用，根据需要可增加至200至300毫克以达到完全抗抑郁疗效。
