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Trz3.8
Trazodone – Forschung
Überwiegend Mechanismus / Beobachtung
32 begutachtete Studien
Was die Evidenz sagt
Überwiegend Mechanismus / Beobachtung
Die meisten Studien zu Trazodone sind mechanistisch oder beobachtend statt RCTs, die einen klinischen Effekt messen — betrachte die Ergebnisse als vorläufig.
Die meiste Evidenz stammt aus hochwertigen Meta-Analysen und randomisierten Studien, veröffentlicht 2011–2026 mit einer typischen Studiengröße von 98 Teilnehmenden.
Basierend auf 32 Studien · 10 Meta-Analysen · 4 RCTs · 96,031 Teilnehmende insgesamt
Konfidenz
Hohe Konfidenz
Nach Outcome
Sleep & insomniaDas stärkste (und dennoch bescheidene) Signal: Eine Metaanalyse fand signifikant weniger Aufwachereignisse unter trazodone, und die Polysomnographie bei Patienten mit primärer Insomnie zeigte weniger nächtliche Aufwachereignisse — jedoch keine signifikante Veränderung der Wachzeit nach Schlafbeginn oder der Gesamtschlafzeit, und die AASM-Leitlinie empfiehlt gegen diese Anwendung · 1-7 Nächte · In einem 7-nächtigen Crossover-Versuch mit 16 Patienten mit primärer Insomnie war der Tiefschlaf an Tag 7 größer als unter Placebo, und der Anteil des Stadium-1-Schlafs war über die Testtage hinweg geringer (an Tag 1 zeigte sich kein Unterschied im Tiefschlaf). Eine einzelne, sehr kleine Studie — kein replizierter Befund · Etwa 1 Woche · Der Evidenz nach praktisch keine: Die Metaanalyse zu trazodone bei Insomnie fand KEINEN signifikanten Unterschied zu Placebo hinsichtlich der Einschlaflatenz, und die AASM-Leitlinie empfiehlt Behandelnden ausdrücklich, trazodone nicht bei Einschlafstörungen einzusetzen · Nicht nachgewiesen
Überwiegend Mechanismus / Beobachtung14 Studien
Therapeutic & clinical
Überwiegend Mechanismus / Beobachtung13 Studien
Depression & mood
Überwiegend Mechanismus / Beobachtung12 Studien
Safety profile
Überwiegend Mechanismus / Beobachtung8 Studien
Cognitive function
Überwiegend Mechanismus / Beobachtung5 Studien
Anxiety & stress
Überwiegend Mechanismus / Beobachtung4 Studien
Heart & blood pressure
Zu wenige bewertete Studien2 Studien
Women's health
Zu wenige bewertete Studien2 Studien
4 weitere Outcomes mit weniger Studien nicht angezeigt.
Aktives Forschungsgebiet
23 Studien in den letzten 5 Jahren · Neueste Meta-Analyse: 2026
201120182026
1Meta-Analyse2022
Einfach gesagt: Many licensed drugs (including benzodiazepines, daridorexant, suvorexant, and trazodone) can be effective in the acute treatment of insomnia but are associated with poor tolerability, or information about long-term effects is not available.
De Crescenzo, D'Alò, Ostinelli, Ciabattini, Di Franco, Watanabe, Kurtulmus, Tomlinson, Mitrova, Foti, Del Giovane, Quested, Cowen, Barbui, Amato, Efthimiou, Cipriani · The Lancet (2022)
170 trials (36 interventions, 47,950 participants) in the systematic review; 154 double-blind RCTs (30 interventions, 44,089 participants) in the network meta-analysis
The agents found more efficacious than placebo for acute treatment were benzodiazepines, doxylamine, eszopiclone, lemborexant, seltorexant, zolpidem and zopiclone (SMD 0.36-0.83) — trazodone was not among them
Trazodone is grouped with the licensed drugs carrying poor tolerability and/or absent long-term data
Einfach gesagt: Clinicians should prioritize risk stratification and consider trazodone for patients requiring rapid symptom relief while integrating non-pharmacological interventions for long-term management.
Hameed AK, Asiri M, Fedwi MM, Jawad M, Prahlad P, Singh A, Chauhan AS, Sahoo S, Singh M, Kadhem M. · Psychopharmacology (2026)
Data extraction, quality assessment using the Cochrane ROB2 tool, and meta-analysis were performed, utilizing the standardized mean difference (SMD) and odds ratios (ORs).
Trazodone significantly improved sleep quality (Pittsburgh Sleep Quality Index: SMD = -0.827, 95% CI: -1.331 to -0.323, p = 0.001) and reduced depression severity (Hamilton Depression Rating Scale: SMD = -0.365, 95% CI: -0.480 to -0.249, p < 0.001).
Clinical Global Impression scores showed non-significant trends favoring trazodone (SMD = -0.209, p = 0.118).
Kokkali M, Pinioti E, Lappas AS, Christodoulou N, Samara MT. · CNS drugs (2024)
When different units or scales were used, Hedge's adjusted g standardized mean difference (SMD) was calculated.
Trazodone did not significantly impact subjective total sleep time (TST) [WMD = 0.73 min, 95% confidence interval (CI) - 24.62; 26.07, p = 0.96] but improved sleep quality (SQ) (SMD = - 0.58, 95% CI - 0.87; - 0.28, p < 0.01) and secondary outcomes.
It may improve sleep quality and continuity but has minor effects on sleep latency, efficiency, and daytime impairment.
Einfach gesagt: In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants (range of ORs 1·19-1·96), whereas fluoxetine, fluvoxamine, reboxetine, and trazodone were the least efficacious drugs (0·51-0·84).
Einfach gesagt: However, given the limited evidence for several interventions, these findings should be interpreted cautiously and confirmed in larger, multicenter studies.
Zhao Y, Mo Q, Liu Y, Chen X, Zhao Q, Wang H, Yan Z, Cao L, Zhao G. · Brain and behavior (2026)
Treatment effects were estimated using standardized mean differences (SMDs) for efficacy and odds ratios (ORs) for safety.
Compared with placebo, citalopram (SMD = -0.99, 95% CI: -1.87 to -0.12) and primary motor cortex (M1) repetitive transcranial magnetic stimulation (rTMS) (SMD = -1.29, 95% CI: -1.93 to -0.64) significantly improved depressive symptoms with moderate-quality evidence.
Several treatments could not be included in the safety network because of insufficient connectivity.
Einfach gesagt: Conclusions For patients undergoing SAEs following the administration of antidepressants, trazodone, vortioxetine, vilazodone and agomelatine are alternative antidepressants.
Wang Q, Xu Z, Chen X, Liu L, Liu X. · Andrology (2025)
The incidences of EjD, erectile dysfunction (ED), decreased libido (DL), adverse events (AE), withdrawal due to adverse events (WDAE) and withdrawal due to lack of efficacy (WDLE) were pooled using odds ratio (OR) with their 95% confidence intervals (CI).
Clomipramine (OR 42.11, 95% CI [9.90, 179.08]), WS5570 (OR 28.99, 95% CI [1.48, 568.97]) and paroxetine (OR 18.63, 95% CI [9.33, 37.23]) had significant risk of EjD comparing to placebo.
Additionally, duloxetine (OR 7.37, 95% CI [2.61, 20.78]), clomipramine (OR 5.29, 95% CI [1.72, 16.25]), paroxetine (OR 3.75, 95% CI [1.37, 10.26]) and escitalopram (OR 3.04, 95% CI [1.20, 7.71]) presented higher risk of ED comparing to placebo.
Einfach gesagt: We suggest that clinicians not use trazodone as a treatment for sleep onset or sleep maintenance insomnia (versus no treatment) in adults. (WEAK).
Sateia, Buysse, Krystal, Neubauer, Heald · Journal of Clinical Sleep Medicine (2017)
The AASM commissioned a task force of four sleep-medicine experts, ran a systematic review of randomised controlled trials, and graded the evidence with GRADE
Trazodone received a WEAK recommendation AGAINST use for both sleep-onset and sleep-maintenance insomnia — the same recommendation given to diphenhydramine, melatonin, tryptophan, valerian and tiagabine
By contrast the guideline suggests clinicians USE doxepin for sleep-maintenance insomnia and suvorexant, eszopiclone, zaleplon, zolpidem, triazolam, temazepam and ramelteon for their respective indications (all WEAK)
Einfach gesagt: Conclusions The proposed algorithm may assist neurologists in the management of depression in patients with PD by providing specific recommendations on the role of trazodone across different clinical scenarios, allowing for individualized treatment.
Antonini A, Bentivoglio AR, Calandra-Buonaura G, Ceravolo R, Leta V, Pellecchia MT, Pilotto A, Nicoletti A. · Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology (2026)
In presence of depressive mood with predominant insomnia, high-dose trazodone should be considered along with mirtazapine.
In case of cognitive deficits with agitation, low to medium dose trazodone is suggested.
Conclusions The proposed algorithm may assist neurologists in the management of depression in patients with PD by providing specific recommendations on the role of trazodone across different clinical scenarios, allowing for individualized treatment.
Einfach gesagt: Further high-quality research is necessary to better define the therapeutic potential of trazodone in the management of neurological conditions.
Verrienti G, Lombardozzi G, Albergo G, De Filippis S. · International journal of psychiatry in clinical practice (2026)
Conclusions Despite being an older antidepressant, trazodone remains widely prescribed.
Beyond treating depression in neurological patients, it may may be useful in the treatment of some neurological aspects.
Einfach gesagt: The emerging role of non-antidepressant agents (e.g., several opioids and antiparkinsonian drugs) as potential precipitants support tailored interprofessional medication review in poly-medicated subjects.
Blyzniuk B, Danukalo M, Gastaldon C, Barbui C, Toto S, Raschi E, Seifritz E, Kuzo N, Schoretsanitis G. · European journal of clinical pharmacology (2026)
Results A total of 764 cases were included; 653 (85.6%) and 496 (65.0%) met the Sternbach and the Hunter Criteria, respectively.
Patients with SS following suicide attempts were more frequently admitted to intensive care units with higher mortality rates than patients with SS related to regular prescriptions (79.4% vs 35.6% and 18.0% vs 5.1%, respectively, both p < 0.001).
Of 645 regular prescription cases, 92.9% were drug combinations (≥ 2 agents).
Einfach gesagt: Future studies should involve larger, high-quality trials with unified methodologies to strengthen the reliability of conclusions.
Zhang X, Chen Y, Deng R, Tao S, Zou M, Wang Q. · Journal of affective disorders (2026)
Background and purpose Insomnia is a common symptom in depressive disorder, affecting up to 80% of those patients.
Results The PSG results showed that agomelatine may not significantly change percentage N1 of sleep period time (N1%) and Latency of REM sleep (L-REM).
Mirtazapine significantly increased total sleep time (TST), slow-wave sleep of sleep period time (SWS%), and sleep efficiency (SE%), while reducing percentage wake after sleep onset of sleep period time (WASO%).
Glasgow-Osment B, Wahib F, Kassam S, Zanin M, Garcia-Bournissen F. · European journal of clinical pharmacology (2025)
However, some studies suggested a possible association with an increased risk of spontaneous and therapeutic abortions.
Given the limited and varied data, further research with larger, well-controlled studies are needed to establish the safety profile of trazodone during pregnancy.
Overall, clarifying the specific risks and benefits of trazodone use in pregnancy will better guide clinical decision-making and improve maternal-fetal health outcomes.
Einfach gesagt: New use of low-dose trazodone was no safer with respect to a risk of a fall-related injury than new use of benzodiazepines.
Bronskill, Campitelli, Iaboni, Herrmann, Guan, Maclagan, Watt, Rochon, Morris, Jeffs, Bell, Maxwell · Journal of the American Geriatrics Society (2018)
Retrospective propensity-score-matched cohort of 7,791 Ontario nursing-home residents aged 66+ newly dispensed low-dose trazodone versus newly dispensed benzodiazepines
Cumulative incidence of hospitalisation for a fall-related injury within 90 days: 5.7% with low-dose trazodone vs 6.0% with benzodiazepines (hazard ratio 0.94, 95% CI 0.83-1.08)
Findings were consistent across sensitivity analyses restricted to hip or wrist fracture and at 30, 60 and 180 days of follow-up
Einfach gesagt: Since our findings are mostly based on post-hoc analyses, the evidence remains preliminary, highlighting the need for further research to produce more conclusive evidence.
Gao S, Chen Y, Liu J, Zhang Q, Zhao X, Liu B, Zhang Y, Li L, Wang G. · Psychological medicine (2025)
Effects were expressed as relative risk (RR) or standardized mean difference (SMD).
Results In patients with MDE-MFS, antipsychotics significantly improved depressive (RR = 1.46 [95% CI: 1.31, 1.61]) and manic (SMD = -0.35 [95% CI: -0.53, -0.17]) symptoms without increasing the risk of manic switch (RR = 0.91 [95% CI: 0.53, 1.55]).
For MDE-MFS in patients with major depressive disorder, trazodone has shown potential effectiveness in retrospective studies, while the effectiveness of antidepressants on BD patients with MDE-MFS lacked evidence.
Einfach gesagt: Larger clinical studies are needed to confirm that CYP2D6 genotyping could contribute to preventing ADRs in clinical practice.
Wiss FM, Krieg CD, Lampert ML, Meyer Zu Schwabedissen HE, Stäuble CK, Mikoteit T, Imboden C, Allemann SS. · Journal of clinical psychopharmacology (2026)
After accounting for phenoconversion and adjusting for sex, trazodone dose, and CYP3A5 phenotype, CYP2D6 poor metabolizers were found to be more likely to develop ADRs compared with normal metabolizers (OR: 8.96; 95% CI=1.67-48.08).
No association with ADRs was found for genetic variants in CYP3A5 and ABCB1 .
Subgroup analysis revealed that reduced CYP2D6 activity was associated with a higher mCPP-to-trazodone ratio and a greater tendency for ADRs.
Gharooee Ahangar S, Hasanpour M, Fatahian R, Zarei P, Mehdizadeh H. · Trials (2026)
Discussion This study is one of the first to compare trazodone and melatonin alone and in combination for insomnia, fatigue, and daytime sleepiness in TBI patients.
The results will help improve treatment strategies for managing sleep problems, fatigue, and daytime sleepiness in individuals with traumatic brain injury.
Einfach gesagt: Finally, we will summarize the endophenotypes responsive to trazodone and atomoxetine and highlight the role of these agents in the management of OSA and its consequences, especially in underserved areas.
Zafari R, Shahbazi M, Amirifard H, Najafi A. · Sleep & breathing = Schlaf & Atmung (2026)
Although standard treatments are available for OSA, the world does not have equal access to the best management approaches for OSA, which could be due to limited financial resources or a limited trained workforce.
Pharmacological agents, if selected wisely based on the endophenotypes of OSA, may offer an appropriate approach for selective cases of OSA who refuse standard treatments or do not have access to the standard care.
This review describes different OSA comorbidities, phenotypes, and endotypes of OSA and the role of trazodone and atomoxetine in the management of them.
Aishah A, Kim M, Gell L, Vena D, Azarbarzin A, Pho H, Norman D, Ojile J, Esmaeili N, Taranto-Montemurro L, Wellman A, Sands S, Messineo L. · Thorax (2025)
Mixed-model analyses compared the effect of vilo-trazo versus placebo on AHI 4 (apnoea-hypopnoea index with 4% desaturations; primary outcome) and hypoxic burden (secondary outcome).