Table of Contents
- What is Trazodone
- Trazodone Uses and Benefits
- Common and Serious Side Effects of Trazodone
- Trazodone Drug Interactions and Warnings
- Typical Trazodone Dosage
- Patient Tips
What is Trazodone
Trazodone is a common antidepressant that’s used to treat depression and insomnia, as well as off-label conditions like anxiety, aggressive behavior in dementia, alcoholism, and bulimia.
Trazodone belongs to a class of drugs called serotonin modulators, which means it works by modulating serotonin in the brain.
The brand name of Trazodone is Oleptro, but it’s also available as a generic from many manufacturers.
Trazodone works differently than other antidepressants in many ways.
It’s well-tolerated by most people, with minimal side effects that usually go away after a month.
It’s also relatively safe compared to other drugs and works rapidly with effects that may be evident within two weeks.
Many antidepressants require at least six weeks to notice a difference.
If you have been on an antidepressant in the past that didn’t work, you may benefit from trazodone.
Here are the nine most common uses of trazodone, plus common side effects that you should watch out for.
Trazodone Uses and Benefits
Works as an Antidepressant
The major depressive disorder affects about 121 million people Worldwide.
It’s the leading cause of disability and the most common mental disorder in the world.
There are dozens of antidepressants on the market and several classes of these drugs.
Selective serotonin reuptake inhibitors (SSRIs) are one of the oldest kinds of antidepressants, and still widely used.
SSRIs and derivatives — SNRIs and NRIs — account for most antidepressants prescribed today.
While trazodone is not one of the most commonly-taken antidepressants, it’s been used to treat depression since the 1970s.
Trazodone is known as a serotonin antagonist and reuptake inhibitor (SARI).
Overall, trazodone has been found to be a well-tolerated and effective antidepressant.
Several short-term studies have found that trazodone can be effective in treating moderate and severe depression.
According to one study, trazodone performed much better than a placebo, and the most common side effects included drowsiness and headache (1).
A double-blind study of more than 100 people compared trazodone and paroxetine.
The study found that both were effective at reducing symptoms of depression.
While paroxetine resulted in a slightly faster onset, there were no differences in how many patients responded.
People who took trazodone reported fewer sleep issues, however (2).
A third study of more than 125 people with depression compared two popular antidepressants – amitriptyline and trazodone – against a placebo.
The study found that trazodone worked better than a placebo to treat anxiety and depression.
Trazodone had fewer adverse effects than amitriptyline.
It also found that trazodone performed better than amitriptyline in some people, but amitriptyline only sometimes performed better than the placebo (3).
About 75% of people in clinical studies noticed an improvement in depression after two weeks on trazodone, but some people need at least four weeks to see an improvement.
One of the biggest advantages of trazodone over traditional SSRI antidepressants is that it controls a wide range of depression symptoms without the adverse effects on sleep.
Can Treat Anxiety and PTSD
About 40 million people in the United States alone suffer from an anxiety disorder.
This is about 18% of the total population.
Anxiety disorders come in many types, including social anxiety disorder, generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD).
Anxiety often goes hand-in-hand with depression, and both conditions tend to be treated with the same medications.
Because trazodone has a sedative and hypnotic effect, research has found that it can be effective in treating a wide variety of anxiety disorders.
It can be the first choice in the treatment of anxiety, or it can be used if SSRIs are not tolerated or ineffective.
Can Treat Insomnia and Sleep Disorders
Insomnia is one of the most common conditions treated with trazodone, especially among patients who have insomnia and depression.
These two conditions are often linked; depression can lead to sleep disorders, while insomnia can increase the risk of depression.
When prescribed at low doses of under 100 mg, trazodone has a sedative effect.
This is why trazodone is the second most commonly-prescribed drug for insomnia.
Many people with Alzheimer’s also suffer from a sleep disorder.
It isn’t fully understood why sleep disturbances affect people with dementia, but it’s likely the result of changes in the brain.
Some Alzheimer’s drugs like donepezil can also lead to insomnia.
And there is evidence that adults with insomnia have a higher risk of developing Alzheimer’s later in life (6).
A double-blind controlled trial conducted at a geriatric medical center compared the use of a placebo or 50 mg of trazodone before bed among Alzheimer’s patients.
The study found that the people who took trazodone slept for 42 minutes longer at night.
The percentage of their nighttime spent sleeping increased more than 8%.
The study concluded that trazodone has significant benefits for patients with Alzheimer’s disease (7).
Patients with other disorders like mood disorders and fibromyalgia can also benefit from better sleep quality while on a trazodone regimen.
One study assessed the effectiveness of trazodone for people with fibromyalgia.
The study involved a dose of 50 to 300 mg of trazodone administered to 66 patients over 12 weeks.
Researchers found trazodone significantly improved sleep quality, sleep efficiency, and sleep duration.
Patients also reported noticeable improvements in pain, anxiety, and depression.
The most unexpected aspect of this study, though, was a severe side effect known as tachycardia (abnormally fast heart rate) in 20% of the study’s participants (8).
Trazodone may be prescribed alone at a low dose, with another antidepressant, or at a higher antidepressant dose, depending on whether you have depression as well as insomnia.
Used to Treat Alcoholism
Alcohol withdrawal can be dangerous and may lead to high blood pressure, irregular heart rate, fever, seizures, agitation, and even death.
This is why alcohol detox is usually done under medical supervision.
As with other treatments for substance abuse, treating alcoholism in a detox center focuses on reducing withdrawal symptoms.
Trazodone can be an effective treatment to decrease both anxiety and depressive symptoms as well as alcohol cravings.
According to research, trazodone helps by blocking norepinephrine receptors to reduce withdrawal symptoms (9).
Researchers have also found that trazodone helps reduce relapse, and helps alcoholics stay sober.
One study found trazodone dramatically reduced alcohol cravings and anxious and depressive symptoms in detoxified patients after three months.
A larger placebo-controlled, double-blind study supported these findings.
Detoxifying from alcohol often comes with sleep disturbances which can contribute to relapse.
May Be Used in Bulimia Treatment
Bulimia nervosa is an eating disorder that involves body image dysmorphia and obsessive food consumption and purging.
Bulimics typically have bouts of overeating or bingeing following by self-induced purging or vomiting.
Two to three percent of women in the United States suffer from bulimia.
A number of studies have shown that trazodone can be an effective tool in treating bulimia.
According to one important study, trazodone can dramatically reduce the frequency of bingeing and purging in bulimia patients.
In a second study, the average dose of 410 mg of trazodone resulted in dramatic improvement.
Of 13 bulimic patients, bingeing and vomiting was reduced to 0 in 4 patients, and by 55% to 99% in 2 patients.
The intensity of carbohydrate cravings and urges to binge also reduced.
It’s important to note that trazodone was also found to help in another consequence of bulimia: throat and dental damage.
Self-induced vomiting can cause dental erosion, reduced salivation, gum disease, dry mouth, and tooth sensitivity from exposure to gastric acid.
Acid reflux can also be a side effect of self-induced vomiting.
This can damage the esophagus and throat, as well as the vocal cords.
By controlling bingeing and purging through trazodone therapy, the throat and mouth can heal over time (14).
May Reduce Aggressive Behavior
Impulsive and excessive aggression is usually treated with antipsychotic drugs, mood stabilizers, and antidepressants.
This behavior is believed to be caused by a serotonin deficiency.
Because trazodone works to reduce serotonin reuptake, it can increase the amount of serotonin in the brain, thus reducing aggressive behavior.
May Ease Dementia Symptoms
Dementia is notoriously difficult to treat, resulting in a progressive decline of function and cognition.
While trazodone can’t treat dementia itself, it is often used to treat two of the most common symptoms: aggression and insomnia.
One study conducted in 2004 analyzed how well trazodone could work to treat behavioral problems associated with frontotemporal dementia (FTD), which affects the frontal lobes.
Trazodone works by boosting extracellular 5-HT levels of the frontal cortex.
The study found trazodone was well-tolerated, and improved eating disorders, depressive symptoms, agitation, and irritability in FTD patients (18).
A second study of dementia patients who had behavioral problems found at least moderate improvement of behavior in 82% of patients.
This study suggested that trazodone could be a better alternative to the benzodiazepines usually used to treat behavioral issues in dementia (19).
Can Be Used in the Treatment of Sexual Dysfunction
Most antidepressants share a common potential adverse effect: impaired arousal, lowered libido, erectile dysfunction, and delayed orgasm.
This side effect is usually reported with antidepressants classified as SSRIs, which cause some type of sexual dysfunction in 60% of patients.
Trazodone, on the other hand, can be used to treat depression, as well as sexual dysfunction.
Researchers have found that patients who take an SSRI along with trazodone experience an improvement in sexual function (20).
A small study found that 20 patients, including men and women, who added trazodone to their existing SSRI treatment for 4 weeks had improvement in sexual desire, orgasm or ejaculation, lubrication or erection, and overall satisfaction.
This was a small study, however, that called for a large-scale, double-blind study to substantiate the results.
Can Treat Adjustment Disorders
Adjustment disorders can lead to hopelessness, stress, and physical symptoms as an overreaction to a stressful event.
Adjustment disorders often develop in childhood or after a major life event as an inability to cope with stress, and they often occur alongside major depressive disorder.
Because symptoms of these two disorders overlap, trazodone and other antidepressants can be used to reduce symptoms of adjustment disorder.
Research has found that trazodone is better at reducing stress, lack of appetite, and insomnia in cancer patients with an adjustment disorder compared to the sedative clorazepate.
Common and Serious Side Effects of Trazodone
Trazodone is better-tolerated than many antidepressants, but you can still experience a range of side effects such as reduced alertness, stomach problems, vomiting, and delayed urine flow.
Side effects range from very common to severe.
Common Side Effects
The following are side effects most common in adults aged 18 to 60 who have no other medical complications and do not take other medications.
Taking other medications, being over the age of 60, or having a medical condition can increase the risk of more serious side effects.
- Muscle aches
- Diarrhea or constipation
- A headache
- Dry eyes or dry mouth
- Erectile dysfunction or low libido
- Tingling or numbness
- Ringing in the ears
- Blurred vision
Can Cause Discontinuation Syndrome
If stopped abruptly, trazodone can lead to serious withdrawal symptoms that may include sleep disturbances, agitation, and anxiety.
Because of this, it’s always important to taper off of trazodone slowly under a doctor’s supervision.
May Cause Drowsiness
Trazodone can make you feel tired and dizzy.
This may affect your ability to drive or use heavy machinery safely.
This side effect is why trazodone is often prescribed for insomnia, but it’s important to avoid driving or other activities that require you to be alert until you know how trazodone affects you.
Do not drink alcohol with trazodone, as this can increase dizziness and sleepiness.
Some People Experience Weight Changes
As with many antidepressants, trazodone may cause weight changes, including weight gain or loss.
While several studies have reported that some people lose or gain weight, research has been conflicting.
Most people who experience weight changes tend to gain weight, but some do report loss of appetite and weight loss.
Can Cause Heart Disorders
Trazadone has been linked to heart disorders in some people.
The risk of developing a heart disorder with trazodone may be higher if you have high blood pressure, a previous heart attack, or existing heart disease.
This medication appears to cause QT prolongation, or an irregular heart rhythm, which may cause seizures, fainting, and loss of consciousness (23).
Newer types of antidepressants like trazodone have been associated with a lower risk of cardiac problems, however.
Priapism Is a Rare Side Effect of Trazodone
While not common, some men who take trazodone develop priapism, a painful condition that results in an erection lasting for at least four hours with no stimulation (24).
Priapism is considered a medical emergency that requires immediate treatment.
In a worst-case scenario, priapism may require surgery.
Unfortunately, priapism as a result of medication like trazodone is the most difficult type of the condition to treat.
Can Decrease Body Sodium
Some people taking trazodone develop low total body sodium levels.
This condition is called hyponatremia, and it’s most common among elderly patients, people on diuretics, and people who are dehydrated.
Can Increase the Risk of Suicidal Thoughts
A black box warning is required on trazodone prescriptions by the FDA, as the medication can increase the risk of suicidal thoughts in some people.
Research indicates this risk is highest during the first five months of taking trazodone, and when the dose is increased or decreased.
The risk of suicidal feelings may also be higher for people under the age of 24.
It’s important to let family members, friends, and your doctor know if you experience symptoms like panic attacks, aggression, abnormal excitement, or suicidal thoughts.
Can Cause Hallucinations at High Doses
Trazodone is not a controlled substance and has not been associated with any type of drug-seeking behavior.
Still, there is some potential for drug abuse.
Trazodone has been linked anecdotally to hallucinations, but only at high doses.
There is also the risk of severe side effects and overdose when trazodone is used at doses high enough to cause this symptom.
Trazodone Drug Interactions and Warnings
Many drugs can affect how trazodone works, or lead to serious drug interactions.
If you are prescribed trazodone, it’s important to discuss any prescription and over-the-counter medications – including supplements and herbs – with your doctor.
There are several drugs known to interact with trazodone:
- Drugs that treat mental illness. This includes SSRIs, thioridazine, and MAOIs.
- Blood thinners like ibuprofen and warfarin.
- Allergy, cough, and cold medications.
- Heartburn medications.
- Medication for fungal infections.
- Medications for HIV/AIDS.
- Some antibiotics.
- Some heart drugs, like verapamil and sotalol.
- Some seizure medications.
In addition to potential drug interactions, some people with other conditions may be advised not to take trazodone.
This medication should not be used by children or teenagers.
You will also need to inform your doctor if you have:
- Mental health disorders
- High or low blood pressure
- Heart problems
- Liver problems
- Kidney problems
Typical Trazodone Dosage
In most patients, trazodone is prescribed at a dosage of 200 to 600 mg when the drug is used to treat major depression.
For off-label treatment of insomnia, trazodone is usually prescribed at 25 to 150 mg per day.
At low doses of 50 to 100 mg, trazodone has a hypnotic effect, while the antidepressant effect is usually seen at doses of at least 150 mg.
At low doses, trazodone works to:
- Block histamine H1 receptors. This reduces histamine’s effect.
- Block α-adrenergic receptors. This reduces the effect of noradrenaline.
- Block serotonin 5HT2. This reduces the effect of serotonin and increases slow-wave sleep activity in the brain.
At higher doses, trazodone:
- Blocks the serotonin transporter (SERT). This increases serotonin levels.
- Stimulates 5-HTIA receptors for an antidepressant effect on the brain.
The following tips and warnings can make it easier to adjust to trazodone:
- Immediate-action tablets should be taken right after eating a snack or a meal.
- A slow-release tablet should be taken in the evening, or just before bed on an empty stomach. Try to take trazodone at the same time every night.
- Never crush or chew slow-release tablets.
- To limit the effect of daytime drowsiness, take most of your dosage at bedtime.
- Never use trazodone hydrochloride tablets within two weeks of using a monoamine oxidase inhibitor (MAOI) medication.
- When taken on an empty stomach, trazodone reaches a peak blood concentration within 60 minutes. When taken with food, it takes 120 minutes.
- Beginning trazodone on a low dose and slowly increasing it may reduce the risk of side effects. Discuss this with your doctor.
- If you miss a dose, take it as soon as you remember. If it’s almost time for the next dose, however, skip your missed dose and continue on schedule. Never take a double dose of trazodone.
- Watch for signs of worsening depression while on trazodone, especially during the first five months.
- Watch for symptoms of serotonin syndrome, a potential side effect of trazodone that can cause confusion, heavy sweating, muscle rigidity, agitation, and fast heart rate.
- Never stop taking trazodone suddenly. This can lead to severe withdrawal symptoms. It’s always recommended to taper slowly off of trazodone over a period of weeks or months under a doctor’s care.
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