Increased rate of trazodone prescribing with bupropion and selective serotonin-reuptake inhibitors versus tricyclic antidepressants

OBJECTIVE: To determine whether trazodone is prescribed significantly more often with selective serotonin-reuptake inhibitors (SSRIs) and bupropion th an with tricyclic antidepressants (TCAs). METHODS: A retrospective analysis of Iowa City Department of Veteran's Affa ir; prescription records from March 1, 1995, to March 1, 1998, was performe d. Antidepressants prescribed only by psychiatrists were included. Concomit ant use was defined as trazodone prescribed on the same date or up to 42 da ys after the fill date of the primary antidepressant. STATISTICS: All compa risons used 2 x 2 chi(2) contingency table. Significance level was set at p < 0.05. RESULTS: Significantly more patients were prescribed trazodone concurrently with bupropion and SSRI antidepressants than with TCAs. Trazodone was pres cribed significantly more often for patients receiving an SSRI (p = 0.0001, chi(2) = 14.59) or bupropion (p = 0.0295, chi(2) = 4.74) than for patients receiving a TCA. There was no significant difference in trazodone use betw een the patients taking SSRIs or bupropion. The percent of patients that re ceived an SSRI, bupropion, or a TCA in combination with trazodone was 27%, 23%, and 13%, respectively. Overall, 23.7% of patients received trazodone c oncomitantly with a primary antidepressant. DISCUSSION: The effects of antidepressants on sleep and on sleep scores of depression rating scales are reviewed. The clinical implications of these f indings are discussed. The literature addressing the effects of antidepress ants on sleep and on sleep scores of depression rating scales is summarized . Although sleep studies suggest that SSRIs may not improve sleep as well a s a TCA, clinical;studies do not often support these findings. Several stud ies report that bupropion may not improve sleep parameters as well as doxep in or trazodone. The clinical implications of these findings are discussed. CONCLUSIONS: We have demonstrated that our clinicians prescribe trazodone a t a significantly higher rate with an SSRI or bupropion than with a TCA. Th e exact reason for this difference is not known. If trazodone is used durin g the first six weeks of an initial antidepressant treatment trial, it shou ld be discontinued to determine whether the patient's sleep disturbance has responded to the antidepressant. More comparison studies among the newer a ntidepressants and between classes of antidepressants concerning their effe cts on sleep in the depressed patient need to be performed.