Trazodone: Effective Relief for Depression and Sleep Disorders
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Synonyms | |||
Trazodone hydrochloride is a prescription medication classified as a serotonin antagonist and reuptake inhibitor (SARI), primarily indicated for the treatment of major depressive disorder (MDD). It demonstrates a unique dual mechanism of action, modulating serotonin activity while offering sedative properties that make it particularly valuable for patients with co-occurring insomnia. With decades of clinical use and a well-established safety profile, trazodone remains a versatile therapeutic option in psychiatric and primary care practice, balancing efficacy with a generally favorable tolerability compared to many first-line antidepressants.
Features
- Active ingredient: Trazodone hydrochloride
- Available in 50 mg, 100 mg, 150 mg, and 300 mg oral tablets
- Generic and brand-name formulations (e.g., Desyrel, Oleptro)
- Serotonin antagonist and reuptake inhibitor (SARI) pharmacologic class
- FDA-approved for major depressive disorder; off-label uses include insomnia, anxiety, and fibromyalgia
- Half-life of approximately 5–9 hours; extended-release formulations available
Benefits
- Effective reduction of depressive symptoms through serotonin modulation
- Improves sleep architecture and reduces sleep latency due to sedative effects
- Lower risk of sexual dysfunction compared to SSRIs and SNRIs
- Non-habit forming with minimal abuse potential
- Useful in elderly populations due to favorable side effect profile
- May alleviate anxiety symptoms associated with depression
Common use
Trazodone is primarily prescribed for the management of major depressive disorder in adults. Its off-label applications are extensive, including treatment of insomnia—particularly where sedation is desired at bedtime—as well as adjunctive therapy for anxiety disorders, fibromyalgia, and alcohol dependence. It is often selected for patients who cannot tolerate the side effects of SSRIs, especially regarding sexual dysfunction. Clinical practice also utilizes low-dose trazodone for sleep initiation in non-depressed individuals.
Dosage and direction
Initial dosing for depression typically begins at 150 mg per day in divided doses, with increases of 50 mg per day every three to four days as tolerated. The maximum recommended dose is 400 mg per day for outpatients and 600 mg per day for inpatients. For insomnia, doses range from 25 mg to 100 mg taken 30 minutes before bedtime. Tablets should be swallowed whole with food or shortly after a meal to minimize dizziness and nausea. Dosage adjustments are necessary in renal or hepatic impairment and in elderly patients.
Precautions
Patients should be monitored for the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and mania. Use with caution in patients with a history of cardiovascular disease, as trazodone may cause QT prolongation. Orthostatic hypotension may occur, particularly in elderly patients. Priapism—a prolonged and painful erection—is a rare but serious adverse effect requiring immediate medical attention. Abrupt discontinuation may lead to withdrawal symptoms; taper gradually.
Contraindications
Trazodone is contraindicated in patients hypersensitive to trazodone or any component of the formulation. Concomitant use with monoamine oxidase inhibitors (MAOIs) is contraindicated due to risk of serotonin syndrome. Should not be used during the acute recovery phase following myocardial infarction. Not recommended in patients with severe cardiac arrhythmias or uncompensated heart failure.
Possible side effects
Common adverse reactions include somnolence (30–50%), dizziness (20–30%), headache (20–25%), dry mouth (15–25%), nausea (15–20%), and blurred vision (10–15%). Less frequently reported are constipation, fatigue, nervousness, confusion, and hypotension. Serious side effects may include serotonin syndrome, QT prolongation, priapism, suicidal thoughts, and hyponatremia. Most side effects are dose-dependent and often diminish with continued therapy.
Drug interaction
Trazodone interacts significantly with CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) and inducers (e.g., carbamazepine, rifampin). Concomitant use with other serotonergic drugs increases risk of serotonin syndrome. May potentiate effects of CNS depressants including alcohol, benzodiazepines, and opioids. Use with warfarin may require INR monitoring. Caution advised with antihypertensives, digoxin, and phenytoin. Avoid combining with MAOIs; a 14-day washout period is recommended.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed one. If regular dosing is interrupted, contact a healthcare provider for guidance on resuming therapy, particularly if using higher doses for depression treatment.
Overdose
Symptoms of overdose may include severe drowsiness, dizziness, nausea, vomiting, respiratory depression, hypotension, priapism, seizures, and coma. Fatalities have occurred with mixed overdoses involving alcohol or other CNS depressants. Management includes gastric lavage, activated charcoal, and supportive care with ECG monitoring. There is no specific antidote; treatment is symptomatic and supportive.
Storage
Store at room temperature (20–25°C or 68–77°F) in a tightly closed container, away from light, moisture, and heat. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Dispose of unused medication through take-back programs or according to FDA-recommended disposal methods.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting, changing, or discontinuing any medication. Individual response to trazodone may vary based on health status, concomitant medications, and other factors. Only a licensed physician can determine the appropriate treatment for your specific condition.
Reviews
Clinical studies demonstrate trazodone’s efficacy in depression with response rates comparable to SSRIs. Patient reviews frequently highlight improved sleep quality and mood stabilization, though some report persistent drowsiness or dizziness. Meta-analyses support its use for insomnia, particularly in low doses. Long-term observational studies note maintained effectiveness with continuous use, though tolerance to sedative effects may develop in some patients.