Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s) and published for informational purposes only. We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Trazodone is a prescription medication approved by the Food and Drug Administration (FDA) in the U.S. to treat depression. However it’s often prescribed for off-label use to treat insomnia. It’s important to note that the drug is not approved for this use by the FDA.
Trazodone is the generic version of the drug; the branded versions are called Desyrel or Oleptro. These names all refer to the same active chemical compound, so we’ll use them interchangeably throughout this article.
In this article we’ll review medical research to determine whether trazodone is safe and effective for treating depression and insomnia. We’ll highlight side effects of the medication, dosage recommendations, and explain whether or not the drug is a controlled substance with legal implications.
Trazodone for Depression
Trazodone has been extensively studied for its ability to treat depressive disorder, as this is the only condition it’s approved by the FDA to treat.
A medical review of trazodone to treat depression was published in the CNS Drugs journal in 2012. The review is extensive, citing over 100 individual publications on the topic. The study authors concluded that the drug is “effective and well tolerated” for treating depression.
Notably, in the majority of clinical trials on trazodone and depression that the study authors reviewed, the average depression scores of patients decreased.
A more recent clinical trial evaluated the efficacy of trazodone for patients with moderate-to-severe depression. The researchers used a metric called the Montgomery-Asberg Depression Rating Scale (MADRS) to measure depression scores. This scale allows depressed patients to report symptoms across a number of categories, such as reduced sleep, inner tension and reported sadness. The highest score is 60, which would indicate the most depressed state possible. The lowest score is 0.
In the trial, trazodone use significantly lowered average MADRS scores, from 27.4 to 7.5 by the completion of week 5.
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 antidepressant 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 can conclude from the available research that trazodone is effective for treating depression in clinically depressed patients.
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 studies on the topic. 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. This was an important study, because this type of insomnia may have different causes than regular 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 can confirm from the available data that trazodone is likely to be effective for insomnia. However, we don’t recommend the drug for that use as it’s not approved by the FDA for that use. While some doctors may still prescribe it, we would recommend that patients only consider drugs approved by the FDA for a specific use, as this is a rigorous process which helps to ensure patient safety.
How Does Trazodone Work?
Trazodone has a unique effect on the brain and body compared to most antidepressants. Most antidepressant drugs are SSRIs, as we outlined in our Trintellix reviews article of a popular SSRI medication, but trazodone has multiple mechanisms of action.
According to StatPearls, which is one of the largest free medical resources maintained by the U.S. government, 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 medication, but it seems to logically 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…”
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. Trazodone has a “black box” warning label on its FDA label for this potential for increased suicidality.
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 are more mild, and 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.
These are relatively low rates for pharmaceutical side effects, which is a good sign.
According to StatPearls, 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 are allowed to increase their dosage if they react well to the medication. 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. We believe this is important information for patients to be aware of.
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 writing this article.
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.
This information suggests that patients should be transparent with their doctor about their alcohol use if they’re considering taking trazodone. Some patients with alcohol use disorders may wish to hide this information from their doctors, but it would be in their best interest to honestly discuss their alcohol use, because getting prescribed this medication while not able to control alcohol use may be a serious health risk.
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 is a rare side effect from this class of drugs.
As we noted in our Lexapro reviews article, many SSRI medications may cause sexual dysfunction, particularly in men, due to their effects on neurotransmitters.
One benefit of trazodone is that it doesn’t appear to have the same risk of sexual side effects as other antidepressant medications, due to its unique effects on the body that we covered previously.
In fact, a clinical trial actually proved 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. This is somewhat common for pharmaceutical medications.
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 these 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 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 much of how fast a drug stays in a patient’s system. 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 we would need much larger trials to conclusively determine so. We don’t recommend using trazodone for anxiety because the drug is not approved by the FDA to treat anxiety.
Trazodone User Reviews
Trazodone has been reviewed many times on Drugs.com since it’s a commonly-prescribed medication. We find this site to be an insightful source of reviews from users of a drug, but we cannot verify the accuracy of any of the information.
The average user rating of trazodone to treat depression on Drugs.com is 6.7/10, which is actually a better score than most of the medications we’ve recently reviewed.
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.”