Trazodone in the Treatment of Depressive Disorder – A Case Study

Case History

The 56-year-old patient has been receiving outpatient psychiatric treatment since 2016, initially for sleep disorders related to the stress of both parents' illnesses in 2016–2017, and from early 2020 for the development of more significant depressive and anxiety symptoms.

• Family History: Neuropsychiatric burden in the family – the mother was treated as an outpatient for anxiety-depressive issues, the father, now deceased, was treated for Parkinson's disease and dementia.
• Personal History: The patient has never been seriously ill. In the past year, she underwent rheumatology examination for suspected rheumatoid arthritis, but the test results showed borderline values, and the diagnosis was not confirmed. She is also being treated for arterial hypertension, hypercholesterolemia, and hypothyroidism.
• Current Medication: ramipril 5 mg, levothyroxine 50 µg, rosuvastatin 10 mg, escitalopram 10 mg, zolpidem 10 mg for insomnia.

Course of Illness

In 2016, the patient sought psychiatric care on the recommendation of her general practitioner for persistent insomnia. The problems developed in connection with long-term stress – she had been caring for both ill parents for several years. The primary issue was sleep disorder, and the patient used hypnotics – zolpidem for about 5-6 months, almost daily, one tablet per day. She described feeling tired, tense, and nervous during the day. Diagnostically, the condition corresponded to a mild to moderate phase of depressive disorder.

She refused any medication other than for sleep. Trazodone was prescribed at a dose of 100-150 mg with good effect. She did not want a higher dose and did not return for follow-up after several months.

She returned to the clinic in January 2020, again on the recommendation of her general practitioner, this time for significant depressive and anxiety issues. The clinical picture was dominated by low mood, difficulty engaging in daily activities, apathy, anhedonia, frequent crying, anxiety, and fear of the future. Symptoms included anorexia (she lost 8 kg over the last 3 months) and insomnia (frequent night awakenings, early morning awakenings, the duration of sleep shortened by about 3 hours compared to what is normal for her). She felt very tired to the point of exhaustion and had difficulty concentrating at work.

She underwent additional examinations to rule out somatic causes of her problems, especially thyroid dysfunction, for which she has been long treated. Laboratory tests (including thyroid hormones) showed all values within the normal range, and similar results were observed at the endocrinology clinic, including ultrasound (therapy unchanged, follow-up in six months).

The condition was diagnostically concluded as recurrent depressive disorder, currently in a moderate phase. A sick leave was issued.

At that time, the patient had been taking escitalopram 10 mg for 2 months with partial effect. She described partial improvement in mood and reduction in anxiety but insomnia persisted, requiring zolpidem several times a week. She also experienced issues in the sexual area (reduced libido, anorgasmia), which worsened with the introduction of the antidepressant escitalopram.

Pharmacological History

• In the past, she took zolpidem 10 mg for about 6 months for insomnia, almost daily.
• In 2016, zolpidem was gradually discontinued, and she took trazodone 100-150 mg for about 3-4 months for sleep with good effect, then discontinued the medication. She felt well until fall 2019.
• At the end of 2019, she took 10 mg of escitalopram for about 2 months with partial improvement in mood and reduction in anxiety, but insomnia persisted, and she complained about sexual issues. For insomnia, she took zolpidem 10 mg almost daily.

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