Every one of us experiences sleeping troubles off and now. However, for some people, getting a good night’s sleep can be a huge challenge. Insomnia, or the inability to sleep at night, is not just about not being able to sleep properly throughout the night. It is also about falling asleep and staying asleep through the night. Sleep deprivation can have a massive impact on every aspect of your life-from work to your health. It affects everything. If you regularly experience trouble sleeping, your doctor may prescribe certain sleeping medications for you, like trazodone. Trazodone is actually an antidepressant drug that is frequently prescribed for treating insomnia as well. If your doctor has prescribed this medication for you, here’s everything you need to know about Trazodone, the sleeping drug.
Overview of Trazodone
Trazodone is an antidepressant drug that has been approved by the US Food and Drug Administration (FDA) for treating depression.(1,2,3,4) The medication works in numerous ways in the body to treat depression. One of the biggest actions it carries out is to regulate serotonin in the brain, which is a neurotransmitter.(5,6,7) Serotonin helps the brain cells communicate with each other and also has an influence on a wide range of activities like mood, thoughts, sleep, appetite, and behavior.(8)
Even when trazodone is administered in lower doses, it can still make you feel tired, relaxed, and sleepy. The medication has this effect as it blocks chemicals in the brain that interact with neurotransmitters like serotonin and others, including alpha1adrenergic receptors, 5-HT2A, and H1 histamine receptors.
Due to this, trazodone is often prescribed by many as a sleeping aid.(9) But is it actually approved as a treatment for insomnia? Let’s take a look.
Is Trazodone Approved For Use As A Sleep Aid?
Even though the US Food and Drug Administration has approved the use of trazodone for treating depression in adults, doctors have been prescribing this drug as a sleeping aid for many years now. The organization approves drugs for treating certain conditions based on the results of the clinical trials. When a doctor prescribes a certain medicine to you for conditions that are other than what has been approved by the Food and Drug Administration, the process is known as off-label prescribing.(10,11,12)
Over the years, off-label prescribing of medication has become a common practice amongst doctors. It is estimated that almost 20 percent of drugs are prescribed for off-label use.(13) Doctors are able to prescribe medications off-label due to their experience and professional judgment.
When it comes to trazodone, it is frequently used for off-label use to help people fall asleep. However, just like any other medication, it may work as a sleep aid better for some people as compared to others. According to a 2017 study, trazodone prescribed in low doses is considered to be safe and effective for the treatment of insomnia.(9)
However, as mentioned above, the Food and Drug Administration currently only approves trazodone for the treatment of depression.
When prescribing trazodone for insomnia, the typical dosage should be kept between 25 mg to 100 mg. Studies have found that a lower dosage of trazodone is also equally effective, and it is also helpful because it causes less daytime sleepiness or drowsiness.(14) There are also fewer side effects of taking a low dosage of this drug as the medication is short-acting.
Though doctors consider trazodone to be safe when used in low doses for treating sleeping disorders like insomnia, many believe that it is not as effective as other drugs like Ambien for such sleep disorders.(15)
If a person is experiencing difficulty sleeping due to depression, they are likely to need a higher dose of trazodone. In such a case, a person also increases the risk of experiencing side effects of this medication due to the relatively higher dosage.
Trazodone is not considered to be habit-forming, meaning that even when taken in a higher dose, a person is unlikely to become addicted to this medicine. Nevertheless, trazodone and other selective serotonin reuptake inhibitors (SSRIs) that are prescribed for the treatment of depression are still known to cause physical dependence when a person uses them for a long time.(16,17,18)
Such type of drug dependence tends to happen when a person gets used to having the drug continuously in their system. As a result of this, they may begin to experience withdrawal symptoms when the drug is no longer present in the system. Physical dependence like this is common with many medications, not just trazodone.
What Are The Benefits Of Taking Trazodone for Sleeping?
Generally, doctors tend to recommend cognitive behavioral therapy or other behavioral and lifestyle modifications as the first line of treatment for sleep disorders like insomnia. If these treatments do not prove to be effective for you, your doctor may prescribe trazodone to help you sleep. However, your doctor is more likely to prescribe trazodone if other sleeping drugs like Xanax, Ativan, Valium, and others have not worked for you. These medications are all short to medium-acting benzodiazepine drugs that are commonly prescribed to help with sleep disorders.(19,20)
Here are some of the benefits of taking trazodone:
It Is An Effective Treatment For Sleep Disorders Like Insomnia: In 2017, a review of several studies that looked at trazodone use for treating insomnia found that the drug was effective in treating primary and secondary insomnia when prescribed in low doses. Other studies have also found the same results.(9,21,22)
It Is Not Addictive: When compared to other medications, especially the benzodiazepine class of drugs like Xanax and Valium, trazodone is not addictive.(23)
Lower Cost: As compared to some of the newer insomnia medications, trazodone is much less expensive because it is readily available in its generic form as well.
It Is A Better Choice For Those Who Have Sleep Apnea: Certain sleep medications are known to adversely affect sleep arousal and obstructive sleep apnea. A 2014 study discovered that taking 100 mg of trazodone can have a positive effect on sleep arousal.(24) Though more research is needed to establish why this happens.
It May Help Prevent Age-Related Mental Decline: Some studies have shown that trazodone may also help improve slow-wave sleep, which may slow down certain types of age-related mental degeneration, especially in older adults.(25)
What Are The Disadvantages and Risks of Taking Trazodone?
Trazodone is known to cause some side effects, especially when you first start taking the medicine. Some of the common side effects of taking trazodone include:
- Sleepiness or drowsiness
- Dry mouth
- Weight changes (though this is a rare side effect that affects only about five percent of people taking the medicine).(26)
While it is rare, but trazodone can cause some severe reactions. According to the Food and Drug Administration, some of the serious risks associated with trazodone include:
- Serotonin Syndrome: This happens when too much serotonin accumulates in the body, causing serious reactions. The risk of developing serotonin syndrome is higher when you are also taking other medicines or supplements that work by increases the levels of serotonin in the body, such as migraine medications. Symptoms of serotonin syndrome may include nausea, vomiting, diarrhea, hallucinations, dizziness, seizures, trouble with balance, headaches, increased heart rate, and muscle tremor, amongst others.(27)
- Cardiac Arrhythmias: The risk of developing changes in your heart rhythm is exceptionally high if you already have underlying heart problems and are taking trazodone.
- Hypotension: A sudden drop in your blood pressure that is more likely to occur when you stand up from a sitting position.
- High Risk of Bleeding: If you are taking medications like blood thinners like Heparin, Plavix, or Warfarin, it increases the risk of bleeding.
It is also possible to overdose with trazodone. This risk is especially high when you drink alcohol, take benzodiazepines or other types of central nervous system depressant medications that slow down your breathing and reaction times.
The symptoms of trazodone overdose are as follows:
- Changes in your heart rhythm
- Respiratory arrest
Drug overdose can be a life-threatening condition, and if you suspect that you might have taken too much of trazodone, you should call 911 or your local emergency service immediately. Seek medical assistance at once.
Trazodone is an antidepressant medication that is common prescribed by doctors for treating sleep problems like insomnia. However, trazodone is usually never the first line of treatment for such sleep disorders. When taken in low doses, trazodone can help you sleep, but it can also lead to daytime drowsiness or sleepiness. While this drug does not cause addiction, there are several side effects associated with it, including drowsiness, dizziness, dry mouth, and lightheadedness.
- Haria, M., Fitton, A. and McTavish, D., 1994. Trazodone. Drugs & aging, 4(4), pp.331-355.
- Stahl, S.M., 2009. Mechanism of action of trazodone: a multifunctional drug. CNS spectrums, 14(10), pp.536-546.
- Fagiolini, A., Comandini, A., Dell’Osso, M.C. and Kasper, S., 2012. Rediscovering trazodone for the treatment of major depressive disorder. CNS drugs, 26(12), pp.1033-1049. Brogden, R.N., Heel, R.C., Speight, T.M. and Avery, G.S., 1981. Trazodone: a review of its pharmacological properties and therapeutic use in depression and anxiety. Drugs, 21(6), pp.401-429.
- Cunningham, L.A., Borison, R.L., Carman, J.S., Chouinard, G., Crowder, J.E., Diamond, B.I., Fischer, D.E. and Hearst, E., 1994. A comparison of venlafaxine, trazodone, and placebo in major depression. Journal of clinical psychopharmacology.
- Fuller, R.W., Snoddy, H.D. and Cohen, M.L., 1984. Interactions of trazodone with serotonin neurons and receptors. Neuropharmacology, 23(5), pp.539-544.
- Garattini, S., De Gaetano, G., Samanin, R., Bernasconi, S. and Roncaglioni, M.C., 1976. Effects of trazodone on serotonin in the brain and platelets of the rat. Biochemical pharmacology, 25(1), pp.13-16.
- den Boer, J.A., Westenberg, H.G., Kamerbeek, W.D., Verhoeven, W.M. and Kahn, R.S., 1987. Effect of serotonin uptake inhibitors in anxiety disorders: A double-blind comparison of clomipramine and fluvoxamine. International clinical psychopharmacology.
- Jaffer, K.Y., Chang, T., Vanle, B., Dang, J., Steiner, A.J., Loera, N., Abdelmesseh, M., Danovitch, I. and Ishak, W.W., 2017. Trazodone for insomnia: a systematic review. Innovations in clinical neuroscience, 14(7-8), p.24.
- Stafford, R.S., 2008. Regulating off-label drug use—rethinking the role of the FDA. New England Journal of Medicine, 358(14), pp.1427-1429.
- Tabarrok, A.T., 2000. Assessing the FDA via the anomaly of off-label drug prescribing. The Independent Review, 5(1), pp.25-53.
- Tabarrok, A., 2009. From off-label prescribing towards a new FDA.
- Ahrq.gov. 2021. Off-Label Drugs: What You Need To Know | Agency For Healthcare Research And Quality. [online] Available at: <https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.html> [Accessed 15 January 2021].
- Greenblatt, D.J., Friedman, H., Burstein, E.S., Scavone, J.M., Blyden, G.T., Ochs, H.R., Miller, L.G., Harmatz, J.S. and Shader, R.I., 1987. Trazodone kinetics: effect of age, gender, and obesity. Clinical Pharmacology & Therapeutics, 42(2), pp.193-200.
- Matheson, E. and Hainer, B.L., 2017. Insomnia: pharmacologic therapy. American Family Physician, 96(1), pp.29-35.
- Haddad, P., 1999. Do antidepressants have any potential to cause addiction?. Journal of Psychopharmacology, 13(3), pp.300-307.
- Guillem, E. and Lepine, J.P., 2003. Does addiction to antidepressants exist? About a case of one addiction to tianeptine. L’Encephale, 29(5), p.456.
- Haddad, P.M., 2005. Do antidepressants cause dependence?. Epidemiology and Psychiatric Sciences, 14(2), pp.58-62.
- Wheatley, D., 1992. Prescribing short-acting hypnosedatives. Drug Safety, 7(2), pp.106-115.
- LADER, M. and MORTON, S., 1991. Benzodiazepine problems. British Journal of Addiction, 86(7), pp.823-828.
- 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), p.469.
- Saletu-Zyhlarz, G.M., Abu-Bakr, M.H., Anderer, P., Gruber, G., Mandl, M., Strobl, R., Gollner, D., Prause, W. and Saletu, B., 2002. Insomnia in depression: differences in objective and subjective sleep and awakening quality to normal controls and acute effects of trazodone. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 26(2), pp.249-260.
- O’Brien, C.P., 2005. Benzodiazepine use, abuse, and dependence. The Journal of clinical psychiatry.
- Eckert, D.J., Malhotra, A., Wellman, A. and White, D.P., 2014. Trazodone increases the respiratory arousal threshold in patients with obstructive sleep apnea and a low arousal threshold. Sleep, 37(4), pp.811-819.
- La, A.L., Walsh, C.M., Neylan, T.C., Vossel, K.A., Yaffe, K., Krystal, A.D., Miller, B.L. and Karageorgiou, E., 2019. Long-term trazodone use and cognition: a potential therapeutic role for slow-wave sleep enhancers. Journal of Alzheimer’s disease, 67(3), pp.911-921.
- Accessdata.fda.gov. 2021. [online] Available at: <https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018207s032lbl.pdf> [Accessed 15 January 2021].
- Goldberg, R.J. and Huk, M., 1992. Serotonin syndrome from trazodone and buspirone. Psychosomatics: Journal of Consultation and Liaison Psychiatry.