“The nefarious Trazodone”
Nefazodone (Serzone) is the second serotonin antagonist and reuptake inhibitor (SARI), developed as a less sedating derivative of trazodone. Nefazodone was released in 1994, and voluntarily withdrawn from market in 2004 by the original manufacturer due to decreasing sales related to rare occurrences of severe liver damage. The risk of severe liver damage is only 1 in every 250,000 to 300,000 patient-years.
Nefazodone is currently available, but rarely prescribed. It has a relatively mild side effect profile. Nefazodone has no anticholinergic activity, and only mildly antihistaminic. It does not cause priapism, which is a possible adverse event with trazodone. Nefazodone does not impair sexual functioning and may actually enhance it.
There are case reports of nefazodone causing visual trailing, which is a disturbance of motion perception where moving objects appear as a series of stroboscopic images. The illusion of trailing is common with LSD (via serotonergic mechanism) but is not associated with prescription psychotropic medications other than nefazodone.
Dosing: The target dose for depression is 200–300 mg divided BID, with max of 600 mg/day (300 mg BID); Start 100 mg BID; May increase by increments of 100–200 mg/day every week; Taper gradually to stop.