Sedative Hypnotics trazodone

Nevertheless, sedative-hypnotic agents often play a useful role in treatment. In particular, by providing a successful night s sleep, these medications can break the cycle of anxious anticipation and dread that afflicts the insomnia sufferer during the night. We generally prefer using zolpidem or zaleplon as a first-line treatment for early-to-middle insomnia. Late insomnia often responds well to trazodone or eszopiclone, and trazodone often is a first choice in the presence of substance abuse for all insomnias. 

Small doses of trazodone (25 to 50 mg) at bedtime may be useful as a sedative-hypnotic. More data are required on pain control and analgesia using low-dose opioids on a short-term basis, which may also benefit anxiety. For example, the use of morphine in patients with advanced disease has been found to be particularly helpful in decreasing their associated anxiety. 

Another antidepressant, namely trazodone, also has significant sedating properties. This may be due to its serotonin 2A antagonist properties, which may act to induce and restore slow-wave sleep (Fig. 7—14). Trazodone can be used safely with most other psychotropic drugs and so is a popular choice when a patient must take another medication that disrupts sleep, such as an SSRI. Other sedating antidepressants that block serotonin 2A receptors include mirtazapine and nefazodone. These agents are occasionally also used for their sedative-hypnotic properties. 

The nonbenzodiazepine sedative-hypnotics zaleplon, zolpidem, and zopiclone are replacing benzodiazepine sedative-hypnotics as first-line treatments for insomnia. Some antidepressants, such as sedating tricyclic antidepressants and trazodone, are also used as sedative-hypnotic agents for the treatment of insomnia. 

Trazodone is not frequently used as a monotherapy for insomnia, but can be combined with sedative hypnotic benzodiazepines in difficult cases... 

Antidepressant medications with sedating properties have been frequently used for insomnia. Although mirtazapine and nefazodone are still being used in patients with depression, trazodone is commonly used for the sole purpose of treating insomnia. Trazodone blocks serotonin 2A receptors and has significant sedating properties. The efficacy of trazodone as an antidepressant occurs at high doses but at lower doses it is safely used as a hypnotic. Mirtazapine and nefazodone also block serotonin 2A receptors and have occasionally been used as sedative-hypnotics. 

D Bupropion. Bupropion is the only agent that has the highest likelihood of causing jitteriness and insomnia at therapeutic doses. All of the other choices have significant sedative properties. Trazodone is commonly used as a hypnotic rather than as an antidepressant. 

Sedative antidepressants, such as amitriptyline, doxepin, or trazodone, in low doses, have hypnotic efficacy and may be less likely to evoke the adverse effects associated with higher doses. 

Trimipramine is a sedating tricyclic antidepressant that has been used as a hypnotic (1) it shares this activity with other drugs of its class, notably amitriptyline, dosulepin, doxepin, and trazodone, and with the tetracyclics mianserin and mirtazapine. Trimipramine may be preferred for this purpose, since it has less effect on sleep architecture, including REM sleep (2), and has only a modest propensity to produce rebound insomnia in a subset of patients (3). Sedative antidepressants may be particularly appropriate for individuals at risk of benzodiazepine abuse and patients with chronic pain (4). The usual pattern of tricyclic adverse effects, especially antimuscarinic and hypotensive effects and weight gain, can be expected. Some authors, enthusiastic about GABA enhancers, contend that antidepressants are not useful hypnotic alternatives (5). 

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