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La AL, Walsh CM, Neylan TC, Vossel KA, Yaffe K, Krystal AD, Miller BL, Karageorgiou E. Long-Term Trazodone Use and Cognition: A Potential Therapeutic Role for Slow-Wave Sleep Enhancers. J Alzheimers Dis 2020; 67:911-921. [PMID: 30689583 PMCID: PMC6398835 DOI: 10.3233/jad-181145] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent studies reveal an association between slow-wave sleep (SWS), amyloid-β aggregation, and cognition. OBJECTIVE This retrospective study examines whether long-term use of trazodone, an SWS enhancer, is associated with delayed cognitive decline. METHODS We identified 25 regular trazodone users (mean age 75.4±7.5; 9 women, 16 men) who carried a diagnosis of Alzheimer's dementia, mild cognitive impairment, or normal cognition, and 25 propensity-matched trazodone non-users (mean age 74.5±8.0; 13 women, 12 men), accounting for age, sex, education, type of sleep deficit (hypersomnia, insomnia, parasomnia), diagnosis, and baseline Mini-Mental State Examination (MMSE). Longitudinal group differences in cognitive testing were evaluated through repeated measures tests over an average inter-evaluation interval of four years. RESULTS Trazodone non-users had 2.6-fold faster decline MMSE (primary outcome) compared to trazodone users, 0.27 (95% confidence interval [CI]: 0.07-0.48) versus 0.70 (95% CI: 0.50-0.90) points per year (p = 0.023). The observed effects were especially associated with subjective improvement of sleep complaints in post-hoc analyses (p = 0.0006). Secondary outcomes of other cognitive and functional scores had variable worsening in non-users and varied in significance when accounting for co-administered medications and multiple comparisons. Trazodone effects on MMSE remained significant within participants with AD-predicted pathology, with 2.4-fold faster decline in non-users (p = 0.038). CONCLUSIONS These results suggest an association between trazodone use and delayed cognitive decline, adding support for a potentially attractive and cost-effective intervention in dementia. Whether the observed relationship of trazodone to cognitive function is causal or an indirect marker of other effects, such as treated sleep disruption, and if such effects are mediated through SWS enhancement requires confirmation through prospective studies.
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Affiliation(s)
- Alice L. La
- University of California San Francisco, Memory and Aging Center, Weill Institute for the Neurosciences, San Francisco, CA, USA,University of California San Francisco, Weill Institute for the Neurosciences, San Francisco, CA, USA
| | - Christine M. Walsh
- University of California San Francisco, Memory and Aging Center, Weill Institute for the Neurosciences, San Francisco, CA, USA,University of California San Francisco, Weill Institute for the Neurosciences, San Francisco, CA, USA
| | - Thomas C. Neylan
- University of California San Francisco, Memory and Aging Center, Weill Institute for the Neurosciences, San Francisco, CA, USA,University of California San Francisco, Weill Institute for the Neurosciences, San Francisco, CA, USA,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Keith A. Vossel
- University of California San Francisco, Memory and Aging Center, Weill Institute for the Neurosciences, San Francisco, CA, USA,University of California San Francisco, Weill Institute for the Neurosciences, San Francisco, CA, USA,
Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Kristine Yaffe
- University of California San Francisco, Memory and Aging Center, Weill Institute for the Neurosciences, San Francisco, CA, USA,University of California San Francisco, Weill Institute for the Neurosciences, San Francisco, CA, USA,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA,
Department of Epidemiology, University of California San Francisco, San Francisco, CA, USA
| | - Andrew D. Krystal
- University of California San Francisco, Weill Institute for the Neurosciences, San Francisco, CA, USA,
Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Bruce L. Miller
- University of California San Francisco, Memory and Aging Center, Weill Institute for the Neurosciences, San Francisco, CA, USA,University of California San Francisco, Weill Institute for the Neurosciences, San Francisco, CA, USA
| | - Elissaios Karageorgiou
- University of California San Francisco, Memory and Aging Center, Weill Institute for the Neurosciences, San Francisco, CA, USA,University of California San Francisco, Weill Institute for the Neurosciences, San Francisco, CA, USA,Neurological Institute of Athens, Athens, Greece,Stanford Sleep Medicine Center, Redwood City, CA, USA,Correspondence to: Elissaios Karageorgiou, MD, PhD, 675 Nelson Rising Lane Suite 190, San Francisco, CA 94158, USA. Tel.: +1 415 502 0588; Fax: +1 415 476 4800; E-mail:
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Mihara K, Yasui-Furukori N, Kondo T, Ishida M, Ono S, Ohkubo T, Osanai T, Sugawara K, Otani K, Kaneko S. Relationship between plasma concentrations of trazodone and its active metabolite, m-chlorophenylpiperazine, and its clinical effect in depressed patients. Ther Drug Monit 2002; 24:563-6. [PMID: 12142643 DOI: 10.1097/00007691-200208000-00016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Relationships between plasma concentrations of trazodone and m-chlorophenylpiperazine (m-CPP) and the clinical effects were studied in 26 patients (12 males and 14 females) with major depression during three weeks' treatment of 150 mg/d trazodone using an open-study design. Depressive symptoms were evaluated by Montgomery Asberg Depression Rating Scale (MADRS), and subjective side effects were assessed by UKU side effects rating scale (UKU) before treatment and at weekly intervals. Plasma concentrations of trazodone and m-CPP were measured by HPLC. There were significant linear relationships between the steady-state plasma concentration (Css) of trazodone and both the final MADRS score (rs = -0.529, P < 0.01) and the percent improvement at 3 weeks (r = 0.442, P < 0.05). Moreover, the proportion of responders (a final MADRS score of 10 or less) was significantly higher in the group with a trazodone concentration greater than 714 ng/mL (6/8 vs 3/18, P = 0.008). No significant correlation was found between UKU score and the Css for either compound nor between the UKU score and the ratio of m-CPP/trazodone. The current study suggests that a therapeutic response is dependent on the plasma concentration of trazodone but not m-CPP and that a plasma trazodone concentration of about 700 ng/mL may be a threshold for a good therapeutic response.
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Affiliation(s)
- Kazuo Mihara
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Japan
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