Advertisement

Real-World Characteristics and Treatment Patterns of Patients With Insomnia Prescribed Trazodone in the United States

      Abstract

      Purpose

      This study sought to describe patient characteristics and treatment patterns among patients with insomnia prescribed trazodone in the United States.

      Methods

      This real-world, retrospective, descriptive cohort study used US commercial insurance claims from July 1, 2009, through June 30, 2019. The index date was the first prescription for trazodone between January 1, 2010, and December 31, 2018, with 6 months for the preindex period and ≥6 months for the postindex period.

      Findings

      Among 5.8 million patients with insomnia, 17.7% were prescribed trazodone, and 357,380 adults (6.2%) and 7564 children (0.1%) met the study eligibility criteria. The mean (SD) age was 48.8 (15.8) years for adults and 14.8 (2.7) years for pediatrics. Most patients were female (229,280 adults [64.2%] and 4481 children [59.2%]). Insomnia due to mental disorder was the most common specific diagnosis. The most common (>25%) comorbid conditions were anxiety, depression, and hypertensive disease, and 1 of 10 had a history of substance abuse. Zolpidem was previously prescribed (73,342 adults [20.5%] and 233 children [3.1%]) and continued to be prescribed. Concomitant antidepressants were most common (216,893 adults [60.7%] and 5414 children [71.6%]), but benzodiazepines (132,740 adults [37.1%] and 1188 children [15.7%]), antiepileptics (115,064 adults [32.2%] and 2103 children [27.8%]), nonbenzodiazepines (90,946 adults [25.4%] and 542 children [7.2%]), and antipsychotics (40,490 adults [11.3%] and 2063 children [27.3%]) were also prescribed.

      Implications

      This study provides current evidence that trazodone use is widespread among patients with insomnia and is often associated with other specific comorbidities, such as psychiatric conditions. A deeper knowledge of the real-world management of patients with insomnia may facilitate steps toward improving sleep quality, daytime functioning, and clinical outcomes for patients.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sateia MJ
        • Buysse DJ
        • Krystal AD
        • Neubauer DN
        • Heald JL.
        Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline.
        J Clin Sleep Med. 2017 Feb 15; 13: 307-349
        • Morin CM
        • Drake CL
        • Harvey AG
        • Krystal AD
        • Manber R
        • Riemann D
        • Spiegelhalder K.
        Insomnia disorder. Nat Rev Dis Primers. 2015 Sep 3; 1: 15026
        • Morgenthaler T
        • Kramer M
        • Alessi C
        • et al.
        Practice parameters for the psychological and behavioral treatment of insomnia: an update: an American Academy of Sleep Medicine Report.
        Sleep. 2006; 29 (Nov): 1415-1419
        • SchutteRodin S
        • Broch L
        • Buysse D
        • Dorsey C
        • Sateia M.
        Clinical guideline for the evaluation and management of chronic insomnia in adults.
        J Clin Sleep Med. 2008 Oct 15; 4: 487-504
        • Bollu PC
        • Kaur H.
        Sleep medicine: insomnia and sleep.
        Mo Med. 2019; 116 (JanFeb): 68-75
        • Cunnington D
        • Junge MF
        • Fernando AT.
        Insomnia: prevalence, consequences and effective treatment.
        Med J Aust. 2013 Oct 21; 199: S36-S40
        • Stickley A
        • Leinsalu M
        • DeVylder JE
        • Inoue Y
        • Koyanagi A.
        Sleep problems and depression among 237 023 communitydwelling adults in 46 low and middleincome countries.
        Sci Rep. 2019 Aug 19; 9: 12011
        • Brownlow JA
        • Miller KE
        • Gehrman PR.
        Insomnia and cognitive performance.
        Sleep Med Clin. 2020; 15 (Mar): 71-76
        • Cipriani G
        • Lucetti C
        • Danti S
        • Nuti A.
        Sleep disturbances and dementia.
        Psychogeriatrics. 2015; 15 (Mar): 65-74
        • Burke SL
        • Hu T
        • Spadola CE
        • Burgess A
        • Li T
        • Cadet T.
        Treatment of Sleep Disturbance May Reduce the Risk of Future Probable Alzheimer's disease.
        J Aging Health. 2019; 31 (Feb): 322-342
        • Owens JA
        • Rosen CL
        • Mindell JA
        • Kirchner HL.
        Use of pharmacotherapy for insomnia in child psychiatry practice: a national survey.
        Sleep Med. 2010; 11 (Aug): 692-700
        • Badin E
        • Haddad C
        • Shatkin JP.
        Insomnia: the sleeping giant of pediatric public health.
        Curr Psychiatry Rep. 2016; 18 (May): 47
        • GriggDamberger M
        • Ralls F.
        Treatment strategies for complex behavioral insomnia in children with neurodevelopmental disorders.
        Curr Opin Pulm Med. 2013; 19 (Nov): 616-625
        • Bossini L
        • Casolaro I
        • Koukouna D
        • Cecchini F
        • Fagiolini A.
        Offlabel uses of trazodone: a review.
        Expert Opin Pharmacother. 2012; 13 (Aug): 1707-1717
        • Stahl SM.
        Essential Psychopharmacology of Depression and Bipolar Disorder.
        2nd ed. Cambridge University Press, New York2000
      1. Trialtrove® (Citeline®, an Informa UK business), 2020.

        • Ashford JW.
        Treatment of Alzheimer's disease: trazodone, sleep, serotonin, norepinephrine, and future directions.
        J Alzheimers Dis. 2019; 67: 923-930
        • Bossini L
        • Coluccia A
        • Casolaro I
        • Benbow J
        • Amodeo G
        • De Giorgi R
        • Fagiolini A.
        Offlabel trazodone prescription: evidence, benefits and risks.
        Curr Pharm Des. 2015; 21: 3343-3351
        • Blackmer AB
        • Feinstein JA.
        Management of sleep disorders in children with neurodevelopmental disorders: a review.
        Pharmacotherapy. 2016; 36 (Jan): 84-98
        • US Economic Data
        Inflation Calculator.
        Medical Care Services. 2021; (Available at) (Last accessed 09 April)
        • Ellis JG
        • Perlis ML
        • Neale LF
        • Espie CA
        • Bastien CH.
        The natural history of insomnia: focus on prevalence and incidence of acute insomnia.
        J Psychiatr Res. 2012; 46 (Oct): 1278-1285
        • Ohayon MM.
        Epidemiology of insomnia: what we know and what we still need to learn.
        Sleep Med Rev. 2002; 6 (Apr): 97-111
        • Fagiolini A
        • Comandini A
        • Catena Dell'Osso M
        • Kasper S
        Rediscovering trazodone for the treatment of major depressive disorder.
        CNS Drugs. 2012; 26 (Dec;): 1033-1049
        • Buysse DJ
        Insomnia.
        JAMA. 2013; 309 (Feb 20): 706-716
        • Bruni O
        • Angriman M
        • Melegari MG
        • Ferri R.
        Pharmacotherapeutic management of sleep disorders in children with neurodevelopmental disorders.
        Expert Opin Pharmacother. 2019; 20 (Dec): 2257-2271
        • Khouzam HR.
        A review of trazodone use in psychiatric and medical conditions.
        Postgrad Med. 2017; 129 (Jan): 140-148
        • Rosenblum M.
        Substance abuse and insomnia.
        Minn Med. 2017; 100 (May): 38-39
        • Ansseau M
        • De Roeck J.
        Trazodone in benzodiazepine dependence.
        J Clin Psychiatry. 1993; 54 (May): 189-191
        • Abad VC
        • Guilleminault C
        Insomnia in elderly patients: recommendations for pharmacological management.
        Drugs Aging. 2018; 35 (Sep): 791-817
        • Jaffer KY
        • Chang T
        • Vanle B
        • Dang J
        • Steiner AJ
        • Loera N
        • Abdelmesseh M
        • Danovitch I
        • Ishak WW
        Trazodone for insomnia: a systematic review.
        Innov Clin Neurosci. 2017 Aug 1; 14: 24-34
        • Kanner AM.
        The treatment of depressive disorders in epilepsy: what all neurologists should know.
        Epilepsia. 2013; 54 (Mar;): 3-12
        • Yang Y
        • Gao X
        • Xu Y.
        The dilemma of treatments for epileptic patients with depression.
        Int J Neurosci. 2015; 125: 566-577
        • Canitano R.
        Mood stabilizers in children and adolescents with autism spectrum disorders.
        Clin Neuropharmacol. 2015; 38 (SepOct): 177-182
        • Bruni O
        • Angriman M
        • Calisti F
        • Comandini A
        • Esposito G
        • Cortese S
        • Ferri R
        Practitioner review: treatment of chronic insomnia in children and adolescents with neurodevelopmental disabilities.
        J Child Psychol Psychiatry. 2018; 59 (May): 489-508