Rosso Gianluca, Benatti Beatrice, Pettorruso Mauro, Sampogna Gaia, Tomasetti Carmine
Department of Neuroscience, University of Torino, Turin, Italy.
Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy.
Front Psychiatry. 2024 Aug 29;15:1362221. doi: 10.3389/fpsyt.2024.1362221. eCollection 2024.
Depressive disorders are leading contributors to the global mental health-related burden, and they represent a challenge for real-world clinicians, due to the low rates of remission despite the high availability of treatments. Often, depression shows in the context of multiple chronic comorbidities, thus requiring precise and accurate management of pharmacological treatments to avoid interactions and side effects. These criticalities call for the need for new strategies of treatment, which may include new insights into the pharmacological properties of currently available antidepressant drugs, to enhance their efficacy in the different contexts in which depression may arise. Trazodone is the prototype serotonin antagonist/reuptake inhibitor antidepressant (SARI). Due to the malleability granted by its multiple formulations, trazodone is frequently used to treat depression, both as an add-on to other antidepressants and as a monotherapy, with satisfying results. Moreover, its tolerability makes it one of the most prescribed antidepressants in patients with poly-treated comorbid medical illnesses, especially in the elderly. Herein, a case series is presented regarding the use of trazodone in patients with complex comorbid diagnoses or distressing side effects. Each of the three cases has been discussed in three specific Round Tables, involving expert clinicians in the fields of Psychiatry, Neurology, General Practice, and Geriatrics using the Nominal Group Technique. The ideas collected have been used to integrate the cases and the discussion with the intent of facilitating accessibility to the widest audience of physicians and clinical workers in different clinical practice contexts. The final aim of this paper is to promote an increasingly personalized use of trazodone in real-world patients with depression.
抑郁症是全球心理健康相关负担的主要成因，对现实世界中的临床医生而言是一项挑战，因为尽管治疗方法众多，但缓解率却很低。通常，抑郁症会在多种慢性合并症的背景下出现，因此需要精确且准确地管理药物治疗，以避免相互作用和副作用。这些关键问题促使人们需要新的治疗策略，这可能包括对现有抗抑郁药物药理特性的新见解，以提高它们在抑郁症可能出现的不同情况下的疗效。曲唑酮是5-羟色胺拮抗剂/再摄取抑制剂类抗抑郁药（SARI）的原型。由于其多种剂型具有灵活性，曲唑酮经常用于治疗抑郁症，既可以作为其他抗抑郁药的附加用药，也可以作为单一疗法，效果令人满意。此外，它的耐受性使其成为合并多种疾病的患者（尤其是老年人）中最常处方的抗抑郁药之一。本文介绍了一系列关于曲唑酮在患有复杂合并症诊断或有令人痛苦的副作用的患者中的使用案例。三个案例中的每一个都在三个特定的圆桌会议上进行了讨论，参与讨论的有精神病学、神经病学、全科医学和老年医学领域的专家临床医生，采用的是名义群体技术。收集到的观点已被用于整合案例和讨论，目的是便于不同临床实践背景下的广大医生和临床工作者获取相关信息。本文的最终目的是促进曲唑酮在现实世界中抑郁症患者中的个性化使用。
