What Is Trazodone?
Trazodone is a prescription medication primarily approved for the treatment of major depressive disorder. It belongs to a class of drugs known as serotonin antagonist and reuptake inhibitors (SARIs). Though not initially developed as a sleep aid, trazodone is commonly prescribed off-label to treat insomnia due to its sedative properties. It is one of the top ten most prescribed medications for sleep.
Why Trazodone Is Prescribed for Insomnia
Trazodone is favored for insomnia, especially among patients who have concurrent depression or anxiety. Unlike traditional sleep aids or benzodiazepines, it is considered to have a lower risk of addiction, making it an appealing option for long-term use.
How Trazodone Works
Trazodone works by altering serotonin levels in the brain, promoting relaxation and drowsiness. It blocks histamine and alpha-adrenergic receptors, contributing to its sedative effects. This mechanism makes it effective for people struggling with sleep onset or maintenance.
Typical Dosage for Sleep
When used for insomnia, the dosage of trazodone is generally lower than when used for depression. Most patients are prescribed between 25 to 100 mg at bedtime. It is crucial to follow the prescriber’s guidance to avoid potential side effects or interactions.
Effectiveness in Managing Insomnia
Clinical evidence supports trazodone’s effectiveness in improving sleep quality, reducing the time it takes to fall asleep, and increasing overall sleep duration. It is especially effective in short-term insomnia and is often preferred for older adults due to its non-addictive profile.
Physical Dependence on Trazodone
Trazodone is not classified as a controlled substance, but it is associated with some potential for physical dependence. While not everyone experiences it, some users may develop withdrawal symptoms—such as dizziness, agitation, or disrupted sleep—especially if the medication is stopped suddenly after long-term use.
Psychological Dependence
Psychological dependence occurs when users believe they cannot sleep without the drug. This can be particularly problematic if trazodone is used daily over long periods, leading to habitual reliance despite its non-addictive classification.
Is It Safe to Take Trazodone with Other Sleep Medications?
Combining trazodone with other over-the-counter (OTC) or prescription sleep medications is generally not recommended unless specifically directed by a healthcare provider. Trazodone already has sedating effects, and combining it with other sedatives—such as antihistamines (e.g., diphenhydramine), benzodiazepines, or non-benzodiazepine hypnotics (e.g., zolpidem)—can significantly increase the risk of excessive sedation, respiratory depression, cognitive impairment, and falls, especially in older adults.
Before using any additional sleep aid alongside trazodone, consult with your prescriber or pharmacist to avoid dangerous interactions and ensure that your treatment plan is safe and effective.
Side Effects to Consider
Common side effects include:
- Drowsiness
- Dizziness
- Dry mouth
- Headache
Serious side effects can include low blood pressure, arrhythmias, and priapism (a prolonged erection). Always report severe reactions to a healthcare provider immediately.
Interactions with Other Medications
Trazodone can interact with other drugs, including MAO inhibitors, other antidepressants, alcohol, and sedatives. These interactions can intensify side effects or reduce therapeutic effects.
Trazodone vs. Traditional Sleep Medications
Compared to benzodiazepines and non-benzodiazepine hypnotics (like zolpidem), trazodone presents a lower risk of addiction and withdrawal, making it suitable for individuals at risk of substance abuse. Additionally, trazodone is not a controlled substance, which simplifies prescribing and monitoring. It is also less likely to cause rebound insomnia upon discontinuation, a common issue with some sedative-hypnotics. Moreover, trazodone’s affordability and long-standing safety profile contribute to its frequent use in clinical practice. While it may not work as rapidly as some short-acting sleep medications, its overall balance of efficacy, tolerability, and low misuse potential often make it a preferred choice for treating insomnia, especially when depression or anxiety are also present.
How Long Trazodone Should Be Used For
Trazodone is typically recommended for short-term use, especially during acute bouts of insomnia or when initiating treatment for underlying depression or anxiety. Most clinical guidelines suggest using sleep medications like trazodone for no more than 2 to 4 weeks without re-evaluation.
When Long-Term Use Might Be Appropriate
Long-term use of trazodone may be appropriate in specific situations, such as chronic insomnia that has not responded to non-pharmacological treatments or when insomnia coexists with chronic depression or anxiety disorders. In such cases, ongoing use should be carefully monitored by a healthcare provider, with regular assessments of efficacy, side effects, and the need for continued treatment.
Clinical Guidelines and Recommendations
Leading clinical organizations, including the American Academy of Sleep Medicine and the American College of Physicians, generally recommend that pharmacologic treatments for insomnia, such as trazodone, be used only after first attempting behavioral interventions like Cognitive Behavioral Therapy for Insomnia (CBT-I). These guidelines emphasize CBT-I as the first-line treatment due to its proven long-term effectiveness and lack of side effects.
When medication is deemed necessary, the guidelines suggest it be used at the lowest effective dose for the shortest possible duration—typically not exceeding four weeks—unless ongoing use is clearly justified. The rationale behind these recommendations includes minimizing the risk of dependence, avoiding side effects, and preventing the masking of underlying conditions that might be contributing to insomnia.
Long-Term Use Concerns
Long-term use should be monitored by a healthcare provider. Risks include tolerance, dependence, and diminished efficacy over time. Tapering under medical supervision is recommended to prevent withdrawal.
Trazodone for Older Adults
Trazodone is often considered a safer alternative for elderly individuals, as it has a lower risk of falls and cognitive impairment compared to other sedatives. However, careful monitoring is essential.
Non-Medication Alternatives
Behavioral therapies like Cognitive Behavioral Therapy for Insomnia (CBT-I), mindfulness practices, and sleep hygiene improvements should be considered alongside or instead of medication.
In fact, research has shown that CBT-I is often more effective than pharmacological treatments in the long term. Studies have demonstrated that while sleep medications like trazodone may offer short-term relief, CBT-I produces sustained improvements in sleep quality, reduces sleep onset latency, and decreases nighttime awakenings. This makes CBT-I the gold standard for treating chronic insomnia, with fewer side effects and no risk of dependence.
Why You or Your Prescriber Might Want You to Stop Taking Trazodone
Trazodone may initially help with sleep issues, but over time, you might notice reduced effectiveness or start experiencing side effects that outweigh the benefits. Some individuals also find themselves relying on the medication psychologically. In addition, your prescriber might want you to stop taking trazodone if you’re experiencing troublesome side effects such as next-day drowsiness, dizziness, or low blood pressure, or if there are concerns about long-term tolerance or interactions with other medications you’re taking. If you feel that trazodone is no longer working for you, or you prefer to explore non-medication approaches, it may be time to consider tapering off.
How to Talk to Your Prescriber About Stopping Trazodone
Open communication with your healthcare provider is essential when thinking about stopping trazodone. Explain your reasons, such as side effects, diminished efficacy, or a desire to pursue alternative treatments. Your prescriber may recommend a gradual tapering schedule to minimize withdrawal symptoms. Learn more about psychological dependence and our blinded tapering approach here. Never stop trazodone abruptly without professional guidance.
When to Seek Medical Advice
If insomnia persists despite trazodone use or if side effects become problematic, consult a healthcare provider. Personalized treatment plans offer better long-term outcomes.
Conclusion: Balancing Benefits and Risks
Trazodone can be a valuable tool in managing insomnia, particularly for individuals with coexisting depression or anxiety. However, its use should be closely monitored by a medical provider. As with all medications, informed use under professional guidance is crucial.
Here at The Insomnia Clinic, we specialize in helping our patients overcome psychological dependence and safely stop sleep medications like trazodone using a blinded tapering process and CBT-I. Click here to learn more about psychological dependence and blinded tapering.
FAQs
- Is trazodone addictive? While not classified as addictive, long-term use can lead to psychological dependence.
- Can I take trazodone every night? Yes, but only under medical supervision.
- 3. How long does trazodone take to work for sleep? It typically begins to work within 30 to 60 minutes.
- 4. What happens if I stop trazodone suddenly? You may experience withdrawal symptoms such as anxiety, dizziness, and insomnia.
- 5. Are there natural alternatives to trazodone for sleep? Yes. Cognitive-Behavioral Therapy for Insomnia (CBT-I) is the “Gold Standard” non-drug alternative.
References
- Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine, 13(2), 307–349. https://doi.org/10.5664/jcsm.6470
- Wichniak, A., Wierzbicka, A., Jernajczyk, W., & Palagini, L. (2017). Sleep and antidepressant treatment. Current Pharmaceutical Design, 23(36), 5826-5842. https://doi.org/10.2174/1381612823666170922150403
- Mendelson, W. B. (2005). A review of the evidence for the efficacy and safety of trazodone in insomnia. The Journal of Clinical Psychiatry, 66(4), 469-476.
- Saletu-Zyhlarz, G., Anderer, P., Gruber, G., Parapatics, S., & Saletu, B. (2002). Effects of trazodone on objective and subjective sleep and awakening quality in depression: A double-blind placebo-controlled study with polysomnography and psychometric assessments. Neuropsychobiology, 46(4), 189–199.
- National Institutes of Health. (2023). Trazodone. MedlinePlus. https://medlineplus.gov/druginfo/meds/a681038.html
- Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C., & Sateia, M. (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of Clinical Sleep Medicine, 4(5), 487–504.
