Evie Summers
Trazodone is an antidepressant medication that was initially developed to treat depression and anxiety. However, it is now often prescribed off-label to treat sleep disorders such as insomnia. Trazodone helps improve sleep by increasing serotonin levels in the brain, which regulates sleep, and blocking histamines, which cause drowsiness. While trazodone can be effective in treating sleep disorders, especially those caused by depression and anxiety, it is not recommended as a first-line treatment due to its side effects and limited clinical evidence.
| Characteristics | Values |
|---|---|
| Developed | 1960s in Italy |
| Approved for use in the USA | 1981 |
| Prescription medication | Desyrel, Desyrel Dividose, Oleptro, Molipaxin, Trazorel, Trittico |
| FDA-approved to treat | Depression and anxiety |
| Blocks | Chemicals in the brain that interact with serotonin and other neurotransmitters |
| Increases | Serotonin in the brain |
| Affects | Histamine, another brain neurotransmitter that keeps you awake and alert |
| May cause | Sleepiness, drowsiness, headaches, morning grogginess, dry mouth, thirst, suicidal thoughts, cognitive decline |
| May help | Prevent cognitive decline, improve slow-wave sleep, improve sleep quality, decrease nightly awakenings, improve sleep efficiency, improve respiratory arousal threshold |
| May be better for | Obstructive sleep apnea (OSA) |
| Not recommended by | The American Academy of Sleep Medicine |
| May not be good for | Everyone |
| Should not be used to treat | Insomnia |
| Should be considered | A short-term solution |
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What You'll Learn
Trazodone's history and development
Trazodone was developed in Italy in the 1960s as an antidepressant medication. It is a phenylpiperazine compound of the serotonin antagonist and reuptake inhibitor (SARI) class. Trazodone increases natural neurotransmitters in the central nervous system, restoring depleted chemicals in the brain. One of these important neurotransmitters is serotonin, which regulates our internal clock for resting and being awake, as well as mood, appetite, digestion, memory, sexual function and desire. Many experts believe that depression involves an imbalance among the brain's neurotransmitters, and trazodone affects the brain's neurotransmitters by inhibiting the uptake of serotonin by nerves and stimulating other nerves.
Trazodone has been used to treat major depressive disorder (MDD) since the 1970s. In 1981, it was approved by the U.S. Food and Drug Administration (FDA) under the brand name Desyrel for use in treating major depressive disorder. It is now also prescribed under the brand name Oleptro to treat sleep disorders such as insomnia, as well as anxiety disorder and unipolar depression. Trazodone was the second-most prescribed agent for insomnia in the early 2000s, although it was not approved for this use.
Trazodone has a sedative effect, causing drowsiness and a relaxed, sleepy feeling. This side effect highlighted its potential use as a sleep aid. While trazodone is often helpful for geriatric patients with depression who have severe agitation and insomnia, it can also cause orthostatic hypotension, which may cause dizziness and increase the risk of falling. This side effect, along with sedation, makes trazodone less acceptable for geriatric patients.
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Trazodone's side effects
Trazodone is an antidepressant that increases serotonin levels in the brain, which helps regulate sleep, mood, hunger, and body temperature. While trazodone is not FDA-approved for treating insomnia, it is often prescribed off-label to treat sleep disorders due to its sedative effects. However, it's important to note that trazodone may cause several side effects, and its effectiveness in treating insomnia is questionable.
Some common side effects of trazodone include:
- Dry mouth: This can be temporarily relieved by sugarless gum or candy, melting ice in the mouth, or using a saliva substitute. However, prolonged dry mouth can increase the risk of dental issues, so consult a doctor if it persists for more than two weeks.
- Dizziness, lightheadedness, and fainting: These symptoms can occur when getting up too quickly from a lying position. To prevent this, get out of bed slowly and rest your feet on the floor for a few minutes before standing up.
- Morning grogginess: This side effect typically improves as your body adjusts to the medication.
- Sleepiness or tiredness: This is more likely to occur if trazodone is taken during the day. Adjusting the dosage timing to the evening may help.
- Headaches: Consult a doctor if headaches persist for more than a week or are severe.
- Constipation or difficulty urinating: These issues should be discussed with a doctor if they become problematic.
- Increased bruising: Consult a doctor if you experience unusual or excessive bruising.
- Increased susceptibility to infections: Report any persistent infections, such as sore throat or skin infections, to your doctor.
Serious side effects are rare, occurring in less than 1 in 1,000 people. However, it is important to be aware of them. These rare side effects include:
- Yellowing of the skin or eyes, which may indicate liver problems.
- A long-lasting and painful erection that lasts longer than 2 hours.
- Severe allergic reaction (anaphylaxis), with symptoms such as swollen lips, mouth, throat, or tongue.
Additionally, trazodone may cause problems with ejaculation and can interact with other medications, including alcohol. It is important to discuss any other medications or supplements with your doctor before taking trazodone.
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Trazodone's effectiveness for treating insomnia
Trazodone is an antidepressant medication that increases serotonin levels in the brain. Serotonin regulates mood, sleep, hunger, and body temperature. Low serotonin levels can cause depression, anxiety, bipolar disorder, and other mental health conditions. Trazodone is often prescribed off-label to treat insomnia and other sleep disorders, especially when they are caused by depression and anxiety. However, it is not recommended as a first-line treatment for insomnia due to limited clinical evidence of its effectiveness and safety concerns.
Trazodone can help people fall asleep faster and decrease nightly awakenings, but it does not significantly improve total sleep time or sleep efficiency. A 2017 review reported that trazodone helps people fall asleep faster and sleep longer. Another review published in 2023 found that trazodone significantly decreased nightly awakenings and slightly improved sleep quality. However, research suggests that trazodone only reduces the time it takes to fall asleep by about 10 minutes and reduces the time spent awake at night by only eight minutes on average.
The American Academy of Sleep Medicine does not recommend trazodone as a treatment for insomnia due to its limited effectiveness. Additionally, trazodone has more adverse effects than a placebo, including morning grogginess, dry mouth, and thirst. It also has a higher fall risk than other sleep aids such as zolpidem or benzodiazepines. Despite this, many healthcare providers prescribe trazodone as a first-line treatment for insomnia, especially when it is caused by depression or anxiety.
Trazodone is generally considered safe for short-term use for sleep issues, but there is limited safety data available for long-term use. It is important to note that trazodone may not be effective for everyone and can cause unwanted side effects, such as drowsiness, headaches, and an increased risk of falls and fractures. It is also important to discuss possible side effects and concerns with a doctor before taking trazodone, as it may interact with other medications.
There are alternative treatments for insomnia that are recommended before resorting to sleep medication. Cognitive Behavioral Therapy for insomnia (CBTi) is a form of talking therapy specifically developed to treat insomnia, and it is considered very effective. Other non-pharmacological methods include improving sleep hygiene, practicing relaxation techniques, and cognitive behavioral therapy (CBT). If these treatments are ineffective, a doctor may then recommend over-the-counter or prescription medications to help with sleep.
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Trazodone's impact on serotonin levels
Trazodone is an antidepressant medication that was developed to treat depression. It is FDA-approved to treat depression and anxiety, but it is often prescribed off-label to treat sleep issues and disorders such as insomnia. Trazodone is known to cause sleepiness and drowsiness, which is a side effect that has highlighted its potential to be used as a sleep aid.
Trazodone impacts serotonin levels by blocking the absorption of serotonin and other neurotransmitters in the brain. It helps serotonin build up in the spaces between nerve cells by blocking it from entering nearby cells. This action increases the serotonin levels in the brain. Serotonin is a neurotransmitter that regulates mood, sleep, hunger, and body temperature. Low serotonin levels are associated with depression, anxiety, bipolar disorder, and many other mental health conditions.
Trazodone also affects histamine, another brain neurotransmitter that keeps one awake and alert. Trazodone may cause sleepiness by blocking histamines, similar to the effect of the common antihistamine Benadryl (diphenhydramine). In addition to histamine, trazodone also interacts with other neurotransmitters such as 5-HT2A, alpha1 adrenergic, and H1 histamine receptors.
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Trazodone's alternatives
Trazodone is a prescription medication that has been used to treat depression and anxiety for many years. It is often prescribed off-label to treat insomnia and other sleep disorders. However, it is important to note that trazodone has limited clinical evidence for its effectiveness in treating insomnia, and it may not be suitable for everyone due to its side effects and interaction with other medications.
If you are considering alternatives to trazodone for treating sleep problems, there are several options available, including:
- Over-the-counter (OTC) sleep aids: These can be a good alternative if you want to avoid prescription sleep medications. Most OTC sleep aids contain ingredients like diphenhydramine (also found in Benadryl) or doxylamine (found in Unisom), which can cause drowsiness. However, it is important to note that these medications can have side effects such as dizziness, falls, memory issues, and prolonged grogginess, especially in individuals over 65 years old.
- Prescription sleep medications: Other prescription sleep medications like zolpidem, benzodiazepines, or Ramelteon (Rozerem) can be considered. These medications work by promoting the body's natural sleep hormone, melatonin, to help improve sleep. It is important to discuss the potential side effects and risks of these medications with your healthcare provider.
- Alternative prescription medications for depression: Since trazodone is often used to treat sleep problems associated with depression, alternative antidepressants can be considered. These include serotonin modulators, atypical antidepressants like mirtazapine, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) such as doxepin, and monoamine oxidase inhibitors (MAOIs). These alternatives may have different uses, side effects, and dosages, so switching between antidepressants is common to find the best fit for the individual.
- Bupropion: This is another antidepressant that has been found to have a better sleep profile compared to other modern reuptake inhibitors, as it is not associated with daytime sleepiness and has a low rate of sleep disturbance. However, common side effects include agitation, dry mouth, constipation, headache, nausea, and dizziness, and it carries an increased risk of seizures.
- Cognitive Behavioral Therapy (CBT): CBT is a form of talking therapy that can be specifically tailored to treat insomnia (CBTi). It is recommended by experts as the first line of treatment before sleep medication. CBTi helps individuals identify and manage distressing thoughts and behaviours that may be contributing to their sleep problems.
- Lifestyle changes and diet modifications: Making lifestyle changes, such as incorporating regular exercise and meditation practices, can positively impact your overall well-being and sleep quality. Additionally, adopting a Mediterranean diet, which includes a variety of fruits, vegetables, grains, healthy fats, and moderate amounts of dairy, eggs, fish, and poultry, has been linked to improved mental health and reduced depression.
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Frequently asked questions
Trazodone is an antidepressant medication that was developed in the 1960s in Italy to treat depression and has been used to treat major depressive disorder (MDD) since the 1970s.
Trazodone blocks chemicals in the brain that interact with serotonin and other neurotransmitters, such as histamine, which keeps you awake and alert. This causes drowsiness, which is why it is often prescribed off-label to treat insomnia.
Trazodone may cause side effects, especially when first starting the medication. These may include drowsiness, headaches, morning grogginess, dry mouth, and thirst. It can also cause more serious side effects, including an increased risk of falls and fractures in older people, and suicidal thoughts, particularly in children and young adults.
A low dose of between 25 mg and 100 mg, taken 30 minutes before bedtime, may be effective for promoting better sleep.
Yes, there are several alternatives to trazodone, including other medications such as Zolpidem (Ambien), eszopiclone (Lunesta), or zaleplon (Sonata). Cognitive Behavioural Therapy for insomnia (CBTi) is also recommended as a first-line treatment before sleep medication.
