Trazodone

Trazodone: Uses, Side Effects & Risks


 

Trazodone is one of the oldest pharmaceuticals on the market. Doctors have used this drug since the 1960s to treat a variety of conditions, including depression, anxiety, and insomnia — although its primary purpose is as an antidepressant. While its longevity means its effects are well studied, trazodone isn’t ideal for all situations. It also has side effects, even when prescribed by a medical professional. Here’s what you need to know if your doctor has suggested trazodone to treat depression or sleep disorders.  

 

What is Trazodone?

Trazodone is classified as a serotonin antagonist reuptake inhibitor (SARI), a drug group that blocks the reabsorption of serotonin. Originally created as an antidepressant, it has been successfully used for the treatment of depression, including depression in those with certain forms of bipolar disorder. You might see it under the brand names Oleptro or Desyrel. 

Although the FDA has only approved trazodone to treat depression, doctors may also prescribe it off-label as a sleep aid for those struggling with insomnia. Its most common side effect is sedation, which may help a person fall or stay asleep, or get back to sleep if they wake during the night. 

 

How Trazodone Affects the Brain

As a SARI, trazodone works by preventing the reabsorption of serotonin. This allows serotonin to become more readily available, eventually building up in the brain and occupying the spaces that naturally exist between nerve cells. This can decrease feelings of depression, as the higher serotonin levels are used to stimulate more neurons.

 

Trazodone vs. Ambien

Although trazodone is not a federally approved sleep medication, its sedative properties have made it effective enough at treating insomnia that many doctors feel comfortable using it as such. Some recommend it off-label as an alternative to ambien, another common sleep aid. 

How do they differ? To start, ambien and trazodone affect the brain differently. Rather than a SARI, ambien is a benzodiazepine. It acts similarly to many tranquilizers or sedatives, including more potent “benzos” like Xanax or Valium.

While it isn’t entirely clear how, it’s believed that ambien works by increasing the availability of gamma-aminobutyric acid (GABA), a primary inhibitory neurotransmitter that slows the action of brain neurons leading to sedation. Ambien has a short half-life, meaning it works quickly and doesn’t remain in the body for very long. Comparatively, trazodone can take time to become consistently effective. Because of this, ambien is generally considered more effective than trazodone.

However, ambien can lead to some notable side effects. Next-day drowsiness or cognitive issues can occur, which could potentially lead to parasomnia, a collection of sleep disorders that involve abnormal movements, emotions, perceptions, and behaviors while falling asleep, sleeping, or when waking up. Tolerance and physical dependence can occur quickly and are likely to occur.

 

Side Effects

Trazodone side effects range from mild to serious. As with many drugs used to treat depression, the FDA has issued a warning that trazodone may increase the likelihood of suicidal thoughts or actions. Teens and young adults are more likely to be affected. The chance of experiencing side effects is lower with trazodone than with ambien, although the list of potential unwanted conditions is lengthy:  

  • Sleepiness
  • Lightheadedness, Dizziness, or Fainting
  • Headache
  • Blurred Vision
  • Dry Mouth
  • Anxiety or Nervousness
  • Nausea or Vomiting
  • Heart Palpitations, Rapid Heart Beat, or Abnormal Heart Rhythms
  • Fatigue
  • Digestive Issues (including Constipation or Diarrhea)
  • Low Blood Pressure or Orthostatic Hypotension
  • Anemia
  • Abnormal Bleeding or Bruising
  • Rash
  • Muscle Pain
  • Confusion
  • Tremors
  • Movement Difficulties (Walking, Coordination, etc.)
  • Weight Changes
  • Tardive Dyskinesia
  • SIADH
  • Priapism
  • Depression
  • Mania or Hypomania
  • Psychosis Exacerbation
  • Hallucinations
  • Suicidal Thoughts
  • Neutropenia
  • Serotonin Syndrome
  • Seizures
  • Heart Attack
  • Stroke

Those taking trazodone need to be under the care of a medical professional. If any side effects are experienced, it’s best to speak with your doctor or, for life-threatening situations, call 911.

 

Overdose Symptoms

Although trazodone overdose is rare, the symptoms can be serious. If you experience any of the following, it’s time to call your doctor:  

  • Loss of Muscle Coordination
  • Nausea and Vomiting
  • Priapism (Persistent or Painful Erection) 
  • Respiratory Arrest
  • Seizures
  • Changes in Heart Rhythm or Heart Attack
  • Serotonin Syndrome

It’s also important to never mix trazodone with alcohol or other drugs, which can be fatal.   

Is Trazodone Safe?

Generally speaking, trazodone is safe for most people. There have been no deaths or heart complications reported for individuals taking trazodone without other medications or substances. Additionally, trazodone’s longevity suggests that there have been no reasons to remove the drug from the market.

However, that doesn’t mean trazodone is safe for everyone. Along with the potential for side effects, there are other considerations.

Not all people should consider using trazodone for the treatment of insomnia or other conditions. People under the age of 25 should typically avoid trazodone to avoid the risk of suicidal thoughts, and the elderly should only use it with caution. Pregnant or breastfeeding women also should not take trazodone in most cases.

People recovering from a heart attack should also not use trazodone. Trazodone may also not be appropriate for individuals with certain psychiatric conditions, such as certain forms of bipolar disorder and schizophrenia, or anyone at risk of suicide.

If you have a history of seizures, cerebrovascular disease, heart disease, kidney problems or liver problems, you may also need to exercise caution. Similarly, if you take other medications or use certain drugs (legal or illegal), it’s important to be upfront with your doctor before taking trazodone, as it can interact with other substances.

How to Quit

It is not wise to stop taking trazodone cold turkey. Although doctors should only prescribe this drug for short-term use, this guideline isn’t always followed. Long-term use of trazodone can lead to dependence and withdrawal symptoms, including agitation, confusion and irritability. Tapering under professional guidance will help you overcome dependence, while reducing the odds of antidepressant discontinuation syndrome, a withdrawal condition characterized by depression, anxiety, irritability and flu-like symptoms.

If you have experienced withdrawal symptoms related to trazodone or other sleep medications, you are not alone. Call the number below to speak with a clinician about your unique needs and the best treatment option for you.