Pharmacological management of aggressive challenging behaviour (ACB) in people with intellectual disabilities ordinarily prioritises the use of antipsychotics, which have significant adverse effects. Antidepressant prescribing for this indication is increasing, with relatively favourable side effect profiles, but without evidential support of efficacy. Trazodone is used in the evidence-based management of aggression in other populations and typically lacks the side effects of commonly prescribed antidepressants. This study aims to review the evidence of trazodone for managing ACB in people with intellectual disabilities.
A rapid review methodology was used to report findings following PRISMA guidance. The search strategy was carried out in Embase, MEDLINE and PsycInfo for articles reporting primary data on trazodone to manage ACB in people with intellectual disabilities. It was run twice in November 2023 and April 2024. Additional articles were identified from references of articles retrieved by the search strategy. Inclusion and exclusion criteria were designed to screen articles.
A total of 174 papers were identified, and four met full inclusion criteria. Three were case studies, and one was a single arm, open label trial. Trazodone was generally effective and well-tolerated in the management of aggressive and challenging behaviour. Limitations included small sample sizes, lack of controls and blinding, lack of subgroup analysis, varied and subjective outcome reporting, dual diagnosis and treatment resistance, little consideration of underlying causes of aggression and wide dose ranges.
This rapid review presents preliminary evidence of an effective, tolerable and safe alternative to usual pharmacotherapies in the management of ACB.
