Trazodone Review: Can an Antidepressant Improve Sleep?

Trazodone Review: Can an Antidepressant Improve Sleep?


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Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regard to prescription medication.

Trazodone, sometimes referred to by its full chemical name trazodone hydrochloride or trazodone HCL for short, is a prescription medication approved by the Food and Drug Administration (FDA) to treat depression. The drug is sometimes prescribed off-label to treat insomnia, but it's not approved by the FDA for the treatment of any sleep disorders.

But is trazodone effective for improving sleep quality? Is the drug proven to decrease depression? Does it cause any significant side effects? And how do real users describe its effects?

In this article we'll answer all of these questions and more as we review clinical studies to determine how effective trazodone is for depression and sleep, document side effects of the drug, explain whether the drug has a negative effect on sexual function and if it causes withdrawal symptoms. We'll also share real, unsponsored user reviews of trazodone.

Is Trazodone Effective for Depression?

Trazodone has been extensively studied for its ability to treat major depressive disorder (MDD).

A medical review of trazodone for depression was published in the CNS Drugs journal. The review cited over 100 clinical trials, and concluded that the drug is “effective and well tolerated” for treating depression. Depression scores improved in the majority of the trials.

A more recent clinical trial evaluated the efficacy of trazodone for patients with moderate-to-severe depression.

Trazodone use significantly lowered average depression scores from 27.4 to 7.5 by the end of week 5. That's a decrease of 73%.

Another medical trial examined whether trazodone was effective for treating depression in an elderly population. The researchers found that the drug was similarly effective to another leading antidepressant called imipramine, and significantly more effective than placebo. They noted that trazodone may be an optimal drug for treating depression in elderly populations because it has less risk of cardiovascular side effects than many antidepressants.

We will conclude from the available research that trazodone is effective for treating depression.

Trazodone for Sleep

Although trazodone is not approved by the FDA for insomnia, there are still medical trials evaluating whether it’s effective for treating this condition.

A medical review published in 2017 examined a number of clinical trials on trazodone and depression. The researchers found that trazodone was not only effective for treating primary insomnia (defined as sleep disturbances lasting over one month and not caused by a medical condition), but was also effective for treating secondary insomnia (defined as sleep disturbances caused by an identifiable factor such as a separate medication or a medical condition).

A separate medical trial published in the American Journal of Psychiatry examined whether trazodone could resolve antidepressant-induced insomnia.

The researchers found that trazodone was effective for insomnia suffered as a result of antidepressant use, which is interesting because trazodone itself is an antidepressant. 67% of patients on trazodone reported improvements to sleep quality.

We do not recommend using trazodone for insomnia because the drug is not FDA-approved for that condition. However, this data suggests that trazodone may be especially effective for patients with both depression and insomnia.

Trazodone Side Effects

Trazodone has a number of documented side effects. One of the most important to highlight is the potential for increased suicidal thoughts and behaviors in pediatric and young adult patients. Trazodone has a “black box” warning on its FDA label indicating this risk.

A black box warning is the most severe level of warning issued by the FDA, so we believe this is a side effect that patients should definitely discuss with their doctor before taking this medication. For patients with a history of suicidal thoughts, or with a family history of suicide, their doctor may recommend alternate antidepressants which don’t have this risk.

Suicidal thoughts is a rare side effect of trazodone. The more common side effects were documented in this medical review.

The study authors found that drowsiness was reported by 5.6% of patients, tiredness by 3.1% of patients, gastrointestinal disorders by 3% of patients and dizziness by 2.6% of patients.

The most common side effects of trazodone are relatively mild, but it may be beneficial for guardians of pediatric patients and for young adult patients to speak with their doctor about alternative antidepressants that may not increase the risk of suicidal thoughts.

Trazodone Dosage

According to StatPearls, which is one of the largest free medical databases, the typical dosage range of trazodone is 50 milligrams (mg) to 300 mg. Some patients may receive 600 mg in extreme cases, but this is uncommon.

Like most pharmaceutical medications, trazodone is typically prescribed at a lower dosage, and then patients may be instructed to increase their dosage if they don't experience benefits. The typical initial dosage for adults is 75 to 150 mg per day, and then the dose may be increased every third day until the patient reaches a maximum daily dose of 300 mg.

An interesting medical trial from 1990 found that even at the same dose, trazodone is more likely to be effective when administered at night, because of its secondary benefits to sleep quality. 

Is Trazodone A Controlled Substance?

Many patients are unaware that a prescription drug may also be a controlled substance, which means that the substance may be illegal depending on local jurisdiction if not prescribed by a licensed medical professional. 

Patients often ask whether trazodone is a controlled substance due to its potent effects and frequent off-label use for insomnia, but trazodone is not a controlled substance at the time of updating this article.

This means that neither patients nor doctors should need to concern themselves with legal ramifications of trazodone prescriptions or traveling with the medication throughout the U.S.

Can I Drink Alcohol While Using Trazodone?

We would not recommend drinking alcohol while taking trazodone. The drug may enhance the effects of alcohol leading to unsafe levels of inebriation. 

The FDA label is typically the best place to look for drug interaction information, and trazodone’s label (which we linked previously in this article) notes that deaths from overdose have occurred while combining trazodone and alcohol.

Given this risk, it's important that patients have an honest discussion with their doctor about their alcohol intake, and about whether they can realistically quit alcohol entirely while they're on trazodone.

Patients who are unable to quit alcohol while using trazodone may be prescribed a different antidepressant that has no interaction with alcohol.

Does Trazodone Have Sexual Side Effects?

Patients are often concerned about sexual side effects from antidepressants, and this is a legitimate concern given that sexual dysfunction can be caused by this class of drugs.

Trazodone does not appear to cause sexual side effects for either sex.

In fact, a 2009 clinical trial actually found that trazodone may be effective for reversing sexual side effects caused by other antidepressant medications, because of its ability to normalize serotonin function. Patients of both sexes experienced improved sexual function when taking trazodone with a SSRI compared with taking an SSRI alone.

Does Trazodone Cause Withdrawal Symptoms?

Trazodone does appear to cause withdrawal symptoms in some patients according to a medical study which investigated this topic.

The study authors noted that trazodone may cause “rebound” effects which are uncomfortable as neurotransmitter levels revert back to their typical functioning. They also suggested that this drug be tapered off very slowly due to the risk of withdrawal symptoms.

We strongly recommend that patients consult with their doctor before stopping trazodone use, because the doctor can create a research-backed tapering schedule that should minimize withdrawal symptoms and ensure the safety of the patient throughout the process.

Does Trazodone Cause Weight Gain?

Trazodone is not likely to cause weight gain. This appears to be another favorable feature of this drug compared to other antidepressants.

An extensive medical review of the effects on weight of various antidepressants found that trazodone patients actually lost weight on average (under 1 pound), which made the researchers conclude that trazodone “may have the most favorable weight profiles of all [antidepressants].”

Some patients did gain weight while on trazodone, but the average patient lost a small amount of weight. Since many antidepressants cause weight gain, this suggests that trazodone may be a healthier choice for overweight or obese patients than other antidepressants.

How Long Does Trazodone Stay In Your System?

Trazodone has a half-life of under 10 hours. This indicates how long it takes the body to clear 50% of this medication on average. This suggests that trazodone should be cleared from the system entirely within one day.

10 hours is a relatively low half-life, and explains why trazodone may be more effective when taken at night. Because it’s processed by the body so quickly, trazodone’s secondary benefit to sleep quality may only be experienced by patients who take it at nighttime.

Individual genetics determine how quickly a drug is cleared from the body. Even though trazodone has a short half-life, it may take some patients twice that long to clear the drug from their system.

Is Trazodone Effective for Anxiety?

Trazodone may be prescribed for anxiety, but it is only approved by the FDA as an antidepressant.

A medical study published in JAMA Psychiatry found that trazodone was somewhat more effective than placebo at improving symptoms of anxiety in patients diagnosed with the condition.

A separate medical study found that all patients prescribed trazodone for panic disorder and agoraphobia (fear of open or crowded places) experienced significant improvements.

It seems that trazodone may be effective for anxiety based on early research, but larger trials are needed to conclusively determine so. We don’t recommend using trazodone for anxiety alone, because the drug is not approved by the FDA to treat anxiety, however this data suggests that trazodone may be an effective choice for patients with both depression and anxiety.

How Does Trazodone Work?

Trazodone has a unique effect on the brain and body compared to most antidepressants. Most antidepressant drugs are selective serotonin reuptake inhibitors (SSRIs), but trazodone has multiple mechanisms of action.

According to StatPearls, trazodone is both a serotonin reuptake inhibitor (like SSRI drugs), but also a “serotonin antagonist.” This means that the drug binds to serotonin receptors in the brain to reduce their biological response.

Researchers aren’t exactly clear on why this is effective for an antidepressant, but it seems to suggest that some patients suffering from depression actually have too high a level of serotonin in the brain, and trazodone may be effective for those patients by normalizing its circulating levels of the neurotransmitter.

As stated in the StatPearls resource, “trazodone reduces levels of neurotransmitters associated with arousal effects, such as serotonin, noradrenaline, dopamine.”

Our Mental Wellness Recommendation

We recommend a platform called Brightside to patients on a mental health journey. It's an online therapy and medication platform that connects patients with licensed therapists and doctors from the comfort of their home.

medical review published in the Clinical Psychology & Psychotherapy journal found that online therapy was equally effective to in-person therapy for treating depression, anxiety and PTSD. Therapy may be a good first option for patients who want to avoid the side effects of medication.

Brightside also can connect patients with licensed psychiatrists that can prescribe medication. Some patients choose only therapy, some choose only medication, and some choose both. The brand reports that 86% of members feel significantly better within 12 weeks of treatment.

Patients with and without health insurance can use Brightside. For many patients with health insurance, treatment is entirely covered by insurance.

The cost for medication without health insurance is capped at $95/month and the cost for therapy without health insurance is capped at $299/month.

Interested patients can check out Brightside at this link to the brand's website.

Trazodone User Reviews

Trazodone has been reviewed over 100 times on Drugs.com, which is an online resource that allows patients to publish ratings and personal reviews of their experience using a medication.

The average user rating of trazodone to treat depression is 6.7/10.

The top positive review is from a user named “Gomattgo” who gave the drug a 9/10 rating and claims it helped cure them of a number of health ailments:

“I can't wait to see what the future holds. I strongly recommend this medication for anyone suffering from depression, anxiety, and/or sleep deprivation.”

The top negative review comes from a user named “jess” who claims that trazodone increased their racing thoughts:

“been on trazadone for a while it made me feel terrible couldn't control my mind I thought it was me and all along it was trazadone terrible drug please think before you take this it has ruined my life felt scared all the time really shaky and anxious.”

Stay up-to-date on our research reviews

Conclusion

Trazodone is effective for treating depression and is FDA-approved for that condition.

Trazodone may also be effective for improving sleep quality and curing insomnia. We would consider this a secondary benefit of the drug for patients with depression and insomnia, but we do not recommend using the drug for insomnia alone as it's not FDA-approved for that condition.

The most common side effects of trazodone are relatively mild, like drowsiness and dizziness, but pediatric and young adult patients may be at increased risk of suicidal thoughts when taking the drug.

One benefit of trazodone compared with other antidepressants is it doesn’t appear to cause any sexual side effects or weight gain.




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