Miya Pearson
Trazodone is an antidepressant medication that is often prescribed for the treatment of insomnia. Although it is only officially approved to treat depression, it is commonly prescribed off-label to treat sleep disorders. The typical dosage for sleep is between 25 mg and 100 mg before bedtime, with 50 mg being a common dose. Trazodone is not addictive and may be a safer alternative to other prescription sleeping pills. However, it is not recommended as a first-line treatment for insomnia, and it is not licensed as a treatment for insomnia in the US and UK.
| Characteristics | Values |
|---|---|
| What is Trazodone? | An antidepressant medication that’s often prescribed for the treatment of insomnia |
| Is it FDA approved for sleep? | No, it is not approved by the FDA for treating sleep disorders |
| Dosage | 25 mg to 100 mg before bedtime |
| Side effects | May cause drowsiness, dizziness, and orthostatic hypotension |
| Safety | Generally considered safe to use short-term for sleep issues |
| Addiction | Not addictive |
| Prescription | Prescribed for sleep in the USA, not in the UK |
| Alternative medicines | Zolpidem (Ambien), eszopiclone (Lunesta), or zaleplon (Sonata) |
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What You'll Learn
Trazodone is an antidepressant
Trazodone is available as a generic medication with doses ranging from 50 mg to 300 mg. Its brand-name equivalent, Desyrel, is no longer available in the U.S. Although trazodone is only officially approved to treat depression, it’s still prescribed for other conditions. The typical trazodone dosage for sleep is 25 mg to 100 mg before bedtime. Trazodone is generally considered safe to use short-term for sleep issues. However, the FDA has not approved it for treating sleep disorders.
Trazodone may help improve slow-wave sleep, which may slow certain types of age-related mental decline like dementia in older adults. A 100 mg dose of trazodone may help improve respiratory arousal threshold if you have OSA. This means you may be less likely to wake up during the night. Trazodone may cause some side effects, especially when first starting the medication. These may include drowsiness, dizziness, and orthostatic hypotension.
Five controlled clinical trials evaluated trazodone for the treatment of primary insomnia. Sleep measures were assessed using subjective sleep questionnaires. During the first week, trazodone decreased the time to fall asleep (sleep latency) significantly more than the placebo, and zolpidem decreased sleep latency more than either trazodone or the placebo. Three additional studies examined trazodone’s effects in the treatment of insomnia. They found that 50mg of trazodone administered 30 minutes before bedtime was effective for sleep maintenance but that it was possibly associated with motor and cognitive impairments.
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Doctors prescribe it off-label as a sleep aid
Trazodone is an antidepressant medication that is often prescribed off-label as a sleep aid. While it is only officially approved by the FDA to treat depression in adults, it is commonly prescribed by doctors at lower doses to help with sleep issues. This off-label use is particularly prevalent in the USA, where trazodone has been one of the most widely prescribed sleep aids over the past decade. In 2019, it was the 25th most prescribed drug in the country, with around five million prescriptions for trazodone issued that year alone.
The typical dosage of trazodone for sleep is between 25 mg and 100 mg before bedtime. At these lower doses, trazodone can induce and maintain sleep without causing daytime drowsiness or tolerance, mainly due to its short half-life of 3-6 hours. It is thought that trazodone works as a sleep aid by blocking chemicals in the brain, such as serotonin and histamine H1 receptors, that interact with neurotransmitters. This reduces alertness, making people feel sleepy.
Trazodone is generally considered safe for short-term use as a sleep aid and may offer benefits over other sleep medications. Unlike many other prescription sleeping pills, it is not addictive and does not carry the same risk of dependency. It may also be preferred for older people as it does not increase the risk of falls and fractures. Additionally, trazodone may be beneficial for those with obstructive sleep apnea (OSA) as it can improve respiratory arousal threshold and reduce the likelihood of waking up during the night.
However, it is important to note that trazodone is not recommended as a first-line treatment for insomnia. The American Academy of Sleep Medicine and the American Association of Sleep Medicine do not advise using trazodone for insomnia, and other non-pharmacological methods such as improving sleep hygiene, practicing relaxation techniques, and cognitive behavioural therapy (CBT) should be considered first. While trazodone is generally well-tolerated, it can cause side effects, especially when first starting the medication. These side effects may include daytime sedation, dizziness, and orthostatic hypotension. It is always important to discuss possible side effects and concerns with a doctor before taking any new medication.
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It's not recommended as a first-line treatment for insomnia
Trazodone is a medication that was initially approved by the FDA in 1981 for the treatment of depression in adults. It is an antidepressant that works by regulating the neurotransmitter serotonin, which helps brain cells communicate and influences sleep, thoughts, mood, appetite, and behavior.
While trazodone is often prescribed as a sleep aid, it is not recommended as a first-line treatment for insomnia. This is because it is not officially approved by the FDA for treating sleep disorders, and there is limited data on its efficacy and side effects for this specific use. Prescribing trazodone for sleep is considered "off-label", which means it is being used to treat a condition other than what it was approved for.
The American Academy of Sleep Medicine and the American Association of Sleep Medicine do not recommend trazodone as a first-line treatment for insomnia. Instead, they suggest non-pharmacological methods such as improving sleep hygiene, practicing relaxation techniques, and cognitive behavioral therapy (CBT). Additionally, there are other medications specifically approved for treating insomnia, such as dual orexin receptor antagonist (DORA) drugs, which work by blocking the receptors of the neurotransmitter orexin, promoting sleep.
Furthermore, trazodone may not be suitable for everyone and can cause unwanted side effects, especially at higher doses. Some common side effects include daytime sedation, dizziness, and orthostatic hypotension. It is important for individuals experiencing sleep difficulties to consult with their healthcare provider to discuss all treatment options and determine the best course of action for their specific needs.
While trazodone may be helpful as a short-term solution for sleep issues, it is not recommended as a first-line treatment for insomnia due to its off-label status, limited data on its efficacy and side effects, the availability of alternative treatments, and the potential for unwanted side effects. Individuals struggling with insomnia should explore various options with their healthcare providers to identify the most suitable and safe approach for their condition.
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It may help prevent cognitive decline
Trazodone is an antidepressant medication approved for use by the FDA in 1981. It is commonly prescribed off-label to treat sleep problems, and it is known to cause drowsiness even at lower doses.
Trazodone has been found to improve slow-wave sleep, which may slow certain types of age-related mental decline like dementia in older adults. A study of 25 regular trazodone users with Alzheimer's dementia, mild cognitive impairment, or normal cognition found that non-users experienced a 2.6 times faster cognitive decline than trazodone users. The study also found that the trazodone users experienced subjective improvements in sleep complaints.
A systematic review of 16 studies that evaluated the effect of a minimum dose of 25 mg of trazodone daily, for at least one week, on cognition in adult humans found mixed results. Seven studies showed no effect on cognition, five showed a beneficial effect by improving or reducing cognitive decline, and four evidenced impaired cognitive function. The review highlights the possibility of a dose-independent dual effect of trazodone on human cognition, with acute utilization associated with impaired cognitive function and long-term use associated with preventing cognitive deterioration.
Another systematic review examined the effects of trazodone on human cognition and searched for clinical evidence of its benefits in neurodegenerative diseases. The review found that trazodone has a new mechanism of action, an effect on the unfolded protein response (UPR) pathway, which may be useful in the control of agitation and insomnia in Alzheimer's disease.
While the evidence is mixed, there are indications that trazodone may help prevent cognitive decline, especially in the context of neurodegenerative diseases like Alzheimer's disease and dementia. However, more research is needed to confirm these findings and understand the underlying mechanisms.
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It's not addictive but has some side effects
Trazodone is a medication approved by the FDA for use as an antidepressant. However, it is sometimes prescribed off-label as a sleep aid, with doses typically ranging from 25 mg to 100 mg before bedtime. While trazodone is not addictive, it does have some side effects that users should be aware of.
Firstly, trazodone can cause drowsiness and sleepiness, especially at higher doses. This may lead to daytime sleepiness and impaired motor and cognitive functions. Additionally, trazodone may cause dry mouth, so it is recommended to use sugar-free gum or candy, melt ice chips in the mouth, or use a saliva substitute to alleviate this symptom. Continuing dryness of the mouth may increase the risk of dental issues, so it is important to address this side effect promptly.
Another potential side effect of trazodone is a sudden drop in blood pressure when standing up, which can cause dizziness. It is advised to be cautious when changing positions to avoid this issue. Trazodone may also lead to abnormal bleeding and bruising, especially when combined with certain medications like aspirin, NSAIDs, or blood thinners. It is crucial to inform your healthcare provider if you notice any unusual bleeding or bruising.
Furthermore, trazodone can cause problems with ejaculation and may impact sex drive in different ways for different people. It is also associated with a rare but serious allergic reaction called serotonin syndrome, which can be life-threatening. Symptoms of serotonin syndrome include changes in heart rate or rhythm, such as a fast or skipping heartbeat, and it typically occurs when trazodone is combined with other medicines that affect serotonin levels.
While serious side effects are rare, it is important to be aware of them and consult a healthcare professional if any adverse reactions occur. Additionally, it is recommended to discuss any concerns or existing health conditions with a doctor before taking trazodone to ensure it is safe and appropriate for your individual needs.
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Frequently asked questions
Trazodone is a medication approved by the FDA as an antidepressant in adults. It is also prescribed off-label as a sleep aid.
The typical trazodone dosage for sleep is between 25 mg and 100 mg before bedtime. It is recommended that you consult a healthcare professional to determine the safest and most effective dose for you.
Trazodone is generally considered safe to use short-term for sleep issues. However, it may cause side effects such as drowsiness, dizziness, and orthostatic hypotension. It is important to discuss possible side effects with a doctor before taking trazodone.
Trazodone should not be taken within 14 days of a monoamine oxidase inhibitor (MAOI). It should also be avoided with other serotonin-boosting medications, such as antidepressants, opioid painkillers, and herbal supplements like St. John's wort. Alcohol and other sleeping pills should be avoided to prevent excessive drowsiness.
