Adjuvant Trazodone for Management of Protracted Delirium Tremens

Kathiresan, Preethy; Rao, Ravindra; Narnoli, Shubham; Hans, Gagan; Sharan, Pratap

doi:10.1177/0253717620933436

“…The low anticholinergic effects also make Trazodone safe in elderly people with cognitive impairment and delirium [121][122][123][124].…”

Section: When Depression Gets Old and Sick: Unmet Needs Of Depression...mentioning

confidence: 99%

Treating Depression in Clinical Practice: New Insights on the Multidisciplinary Use of Tradozone

Albert¹,

Tomasetti²,

Marra³

et al. 2023

Preprint

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Depression is estimated to be a leading contributor to the global mental health-related burden. The determinants of this huge prevalence lie in the fact that depressive symptoms may be comorbid in a wide variety of disorders, thus complicating and exacerbating their clinical pictures. This makes the treatment of depressive symptoms even more difficult since many pharmacological and pharmacokinetic interactions should be considered by physicians approaching the therapy. Hence, depression still represents a challenge for both psychiatrists and the other clinicians, in terms of its high rates of relapse and resistance despite well-established protocols. It is also complicated by the well-known latency in its complete response to current antidepressant treatments. In this context, the search for new strategies in antidepressant treatment is mandatory; even including revising the use of “old” pharmacotherapies by considering their specific features may help to perfecting the treatment of depression, both in its standalone psychiatric manifestation and in the framework of other clinical conditions. The results of a consensus of experts regarding the possible use of trazodone as a valuable strategy for addressing the “real world” unmet needs of depression treatment is herein reported. This is based on the unique characteristics of this drug possibly delivering a rapid antidepressant action as compared to other selective serotonin reuptake inhibitors (SSRIs) as well as on its pharmacodynamic malleability and pharmacokinetic tolerability when used in the milieu of other drugs in treating comorbid depressive symptoms.

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“…,Trazodone has demonstrated efficacy in reducing depressive symptoms, anxiety, insomnia, agitation and apathy in both dementia and delirium (117). The low anticholinergic effects also make trazodone safe in elderly people with cognitive impairment and delirium (118)(119)(120)(121). Moreover, recent studies have demonstrated that patients with dementia taking trazodone may have delayed decline in cognition (122).…”

Section: When Depression Gets Old…and Sick: the Unmet Needs Of Depres...mentioning

confidence: 99%

Treating depression in clinical practice: new insights on the multidisciplinary use of trazodone

Albert,

Tomasetti,

Marra

et al. 2023

Front. Psychiatry

5

0

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Depression is estimated to be a leading contributor to the global mental health-related burden. The determinants of this huge prevalence lie in the fact that depressive symptoms may be comorbid in a wide variety of disorders, thus complicating and exacerbating their clinical framework. This makes the treatment of depressive symptoms difficult, since many pharmacological interactions should be considered by physicians planning therapy. Hence, depression still represents a challenge for both psychiatrists and other clinicians, in terms of its high rates of relapse and resistance despite well-established protocols. It is also complicated by the well-known latency in its complete response to current antidepressant treatments. In this context, the search for new strategies regarding antidepressant treatment is mandatory. Revising the use of “old” pharmacotherapies by considering their specific features may help to perfecting the treatment of depression, both in its standalone psychiatric manifestation and in the framework of other clinical conditions. Using a nominal group technique approach, the results of a consensus of expert physicians regarding the possible use of trazodone as a valuable strategy for addressing the “real world” unmet needs of depression treatment in different fields (psychiatry, primary care, neurology and geriatrics) is herein provided. This idea is based on the unique characteristics of this drug which delivers a more rapid antidepressant action as compared to other selective serotonin reuptake inhibitors. It also has pharmacodynamic malleability (i.e., the possibility of exerting different effects on depressive symptoms at different dosages) and pharmacokinetic tolerability (i.e., the possibility of being used as an add-on to other antidepressants with scarce interaction and achieving complimentary effects) when used in the milieu of other drugs in treating comorbid depressive symptoms. Moreover, the large number of formulations available permits finite dosage adjustments, and the use of trazodone for specific pathologies, such as dysphagia. Therefore, although additional studies exploring the real-world conditions of antidepressant treatment are warranted, experts agree on the idea that depressive disorder, in both its standalone and its comorbid manifestations, may surely take advantage of the particular characteristics of trazodone, thus attempting to reach the greatest effectiveness in different contexts.

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“…Alcohol withdrawal delirium mostly occurs 72 hours after the last alcohol drink, but the whole first week is risky [12,22]. Alcohol withdrawal delirium lasts 1 to 8 days or more when progressing to refractory delirium [12,23]. The predictors of delirium during alcohol withdrawal are: systolic blood pressure above 150 mmHg, pulse rate above 100/min, recent withdrawal seizures, withdrawal delirium or seizures in the past, older age, recent misuse of other GABAergic substances, and comorbid somatic disorders [24].…”

Section: Alcohol-induced Deliriummentioning

confidence: 99%

“…Prophylactic uptake of thiamine, atypical antipsychotics, and corrections of metabolic disturbances, should also be provided [2,15]. Trazodone in dose of 50 mg seems to be a useful sedative for inducing sleep in delirious patients, but it has not yet been officially proposed in such manner [6,23]. A significant number of second-line agents have been described for the treatment of mild to moderate alcohol withdrawal syndrome, such as antiepileptics, but data are lacking for their administration in withdrawal delirium [11][12][13]15].…”

Section: Alcohol-induced Deliriummentioning

confidence: 99%

GABAergic Psychoactive Substance-Induced Delirium: Narrative Literature Review

Tomašić

¹

,

Petrović

²

2023

Arch. Psychiatry Res.

0

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Psychoactive substance-induced delirium is delirium which occurs during or immediate after psychoactive substance intoxication, withdrawal or during the use of specific psychoactive substance. It is characterized by sudden onset of disturbed consciousness, disorientation, hallucinations, changed psychomotor activity, insomnia, acute memory impairment, violent, and bizarre behaviour. The most commonly abused psychoactive substances which may induce delirium are those acting on the major inhibitory neurotransmitter gamma aminobutyric acid (alcohol, anxiolytics, sedatives, hypnotics, and gammahydroxybutyrate- GHB. Psychoactive substance-induced delirium may have hyperactive, hypoactive or mixed clinical presentation. Treatment of delirium induced by psychoactive substances is carried out with antipsychotics, anxiolytics, and sedatives, but each of the listed abused psychoactive substances has its own treatment peculiarities. This narrative literature review describes the epidemiology, pathophysiology, clinical presentation, and treatment of delirium induced by intoxication and withdrawal from GABAergic psychoactive substances. The paper summarizes well-known knowledge with the latest research in psychoactive substances-induced delirium.

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Adjuvant Trazodone for Management of Protracted Delirium Tremens

Cited by 4 publications

References 9 publications

Treating Depression in Clinical Practice: New Insights on the Multidisciplinary Use of Tradozone

Treating Depression in Clinical Practice: New Insights on the Multidisciplinary Use of Tradozone

Treating depression in clinical practice: new insights on the multidisciplinary use of trazodone

GABAergic Psychoactive Substance-Induced Delirium: Narrative Literature Review

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