Trazodone

Antidepressant, sleeping pill or both?
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Although trazodone was designed to treat depression and anxiety disorders, the medication is now widely prescribed as a nighttime sleep aid

What is trazodone?

Trazodone was developed in Italy in the 1960s as an antidepressant medication. Due to negative side effects associated with the drug early on—including dizziness, fainting, irregular heartbeat (and in rare cases, priapism in men)—the antidepressant wasn’t widely favored in the medical community. Eventually, however, internists and clinicians recognized potential benefits of the drug, particularly when administered at low doses. In 1981, trazodone (the generic name of the pharmaceutical) was approved by the U.S. Food and Drug Administration (FDA) under the brand name Desyrel for use in treating major depressive disorder. Today, the medication is prescribed under the brand name Oleptro to treat sleep disorders such as insomnia as well as anxiety disorder and unipolar depression.

Does trazodone cause sleepiness?

For many patients, the drug has a sedative effect, inducing a relaxed, sleepy feeling. In prescribing the drug for sleep disorders, physicians typically recommend taking a low dose at bedtime in order to limit the effects of drowsiness. Still, some people report lingering effects, including sluggishness and feeling zapped of energy, particularly upon waking.

How does trazodone help to alleviate depression?

Trazodone increases natural neurotransmitters in the central nervous system, essentially restoring depleted chemicals in the brain. One of these important neurotransmitters—serotonin—regulates our internal clock for resting and being awake, as well as mood, appetite, digestion, memory, sexual function and desire. Many experts believe depression involves an imbalance among the brain’s neurotransmitters (acetylcholine, norepinephrine, dopamine and serotonin.) While the cause of depression is not fully understood, trazodone affects the brain's neurotransmitters by inhibiting the uptake of serotonin by nerves and stimulating other nerves.

How quickly does the drug take effect?

Patients who take the drug for a sleep disorder can experience the sedative effects within 30 minutes, depending on the type used. Patients who take the drug as an antidepressant may not notice symptom relief for one to two weeks, and it may take up to four weeks to experience the full benefits.

Is it safe to take trazodone to treat depression?

Like all medications, trazodone can cause side effects in some people. Ask your physician to discuss all potential side effects as well as drug interactions and potential withdrawal symptoms associated with the medication.

Do all antidepressant drugs work the same way?

While all antidepressant medications are designed to affect brain chemistry, various pharmaceutical formulations of the drugs have different targets and paths. The most commonly prescribed antidepressants are reuptake inhibitors. Reuptake, as described by WebMD, is "the process in which neurotransmitters are naturally reabsorbed back into nerve cells in the brain after they are released to send messages between nerve cells." A reuptake inhibitor, then, keeps levels of neurotransmitters in the gap between nerves, potentially strengthening circuits in the brain that regulate mood. There are three different types: selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and norepinephrine and dopamine reuptake inhibitors (NDRIs). Common SSRIs are Prozac, Zoloft, Paxil, Lexapro, Celexa and Luvox; common SNRIs include Cymbalta and Effexor; and NDRIs are found in only one drug: Wellbutrin.

Because trazodone doesn’t fall under any of these categories, it’s often referred to as an "atypical antidepressant."

Is it safe to take trazodone for insomnia?

Although trazodone was designed to treat depression and anxiety disorders, the medication is now widely prescribed as a nighttime sleep aid for patients who suffer from acute insomnia.

How is trazodone different from other "sleeping pill" drugs?

Trazodone differs from Ambien, Sonata, Lunesta and other "sleeping pill" medications in a few ways:

  • Both Ambien and Lunesta are classified by the FDA as controlled substances because they have the potential for misuse and abuse, including dependence or addiction
  • Because trazodone is not a controlled substance, physicians aren’t limited in how many pills they can prescribe
  • It's an inexpensive generic drug covered by most insurance companies
  • It's not considered to be an addictive substance when used as prescribed

Trazodone should not be taken by pregnant women or women who are breastfeeding.

What risks are associated with taking trazodone to treat depression?

There are heightened risks for patients under age 24, particularly with regard to mental health. According to Medline Plus, the following side effects and symptoms can occur among patients under age 24: "new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement." If any of these symptoms or side effects are experienced, it's crucial to consult a physician or medical professional immediately.

It's also imperative that patients know what to avoid while taking SSRIs, SNRIs or other antidepressants. Whether a person has a cold, is having trouble sleeping or is searching for allergy relief, they should talk to their doctor before self-treating with an over-the-counter medication. According to Psychiatry Advisor, one patient who was taking melatonin for insomnia while also prescribed an SSRI woke up with a "headache, dizziness and feeling like his face was on fire"—signs of elevated blood pressure that could have been severe had he taken higher doses. Taking an antidepressant medication in combination with supplements, such as St. John’s wort or aspirin, can increase the likelihood of upper gastrointestinal bleeding. To avoid adverse drug reactions, experts advise making a list of all medications, supplements and other OTC drugs, and sharing it with your physician prior to taking trazodone.

Is it safe to use trazodone with alcohol or other drugs?

Absolutely not. Since both alcohol and trazodone affect the central nervous system, the consequences of mixing the two can be deadly. And mixing the medication with drugs of abuse can result in the onset of serotonin syndrome, a potentially lethal adverse drug reaction. While the potential for trazodone abuse is fairly low, any amount over 600 mg. in 24 hours is an overdose.

What happens if you take too much trazodone? Can it cause serotonin syndrome?

Serotonin syndrome occurs when, according to Mayo Clinic, "high levels of serotonin accumulate in the body." This is a drug-to-drug interaction involving the over-stimulation of central and peripheral receptors. According to the journal U.S. Pharmacist, "Serotonin syndrome (SS) is caused most often when certain antidepressant agents are taken concurrently with other drugs that modulate synaptic serotonin levels. When patients take two or more antidepressants from different pharmacologic classes, drug-drug interactions may occur; these interactions may lead to potentially severe serotonin toxicity, or serotonin syndrome." Clinical symptoms of serotonin syndrome can develop within two hours—or up to 24 hours—after taking an increased dose or adding another serotonergic drug.

Signs and symptoms of serotonin syndrome:

  • Tremors
  • Muscle aches
  • Sweating
  • Anxiety
  • Confusion
  • Tachycardia
  • Delirium
  • Hallucinations
  • Seizures
  • Renal failure
  • Death

What are the side effects of trazodone?

Trazodone usage can cause a decrease in sodium levels in the body, a disruption of the nervous system or serotonin syndrome. The most common side effects include:

  • Drowsiness (including feeling groggy the next day)
  • Dizziness (including an increased risk of fainting/falling)
  • Dry mouth
  • Constipation
  • Headache
  • Fatigue
  • Tingling or numbness in hands, arms or legs
  • Blurred vision
  • Disorientation
  • Vertigo
  • Nasal congestion
  • Shaking
  • Anxiety
  • Muscle aches
  • Prolonged and painful erections lasting longer than six hours (priapism) 
  • Abnormally low blood pressure
  • Heart rhythm disorders 
  • Increased risk of suicidal thoughts and behavior in children and adolescents (even when taken at approved doses for depression)
  • Acting on dangerous impulses
  • Insomnia (at high doses)
  • Weight gain or loss

The drug can stay in a person's system for 42 hours after the final dose. Higher doses can produce more severe side effects.

Can you become addicted to trazodone?

While the drug is considered non-addictive and non-habit-forming, it should only be taken as prescribed and under a physician's care in order to avoid misuse. This is especially important for individuals who have a history of substance abuse or other drug addiction. Warning signs of drug misuse include using the sleep aid/antidepressant without a prescription, using the medication at higher doses than prescribed, or snorting or crushing the tablets to speed up the intended effects.

Can you fail a drug test while taking trazodone?

Even though the antidepressant/sleep aid is not classified as a narcotic, it can cause false positives on drug tests. According to the National Center for Biotechnology Information, "The trazodone metabolite meta-Chlorophenylpiperazine [m-CPP] can cause false-positive urine amphetamine immunoassay results.…Further, we found that patients taking trazodone can produce urine with sufficient m-CPP to result in false-positive Amphetamines II results."

What are trazodone's withdrawal symptoms?

Although technically a non-addictive substance, regular use of the medication can result in mild physical dependence. For this reason, trazodone withdrawal is a concern. Rather than discontinuing use "cold-turkey," physicians typically recommend a gradual tapering. This approach is considered a better protocol to avoid potential discomfort associated with trazadone withdrawal syndrome, also known as discontinuation syndrome.

Symptoms of trazodone withdrawal include:

  • Agitation
  • Confusion
  • Rapid mood swings
  • Muscle pain
  • Weakness
  • Dizziness
  • Stomach pain
  • Sweating
  • Insomnia
  • Fatigue

If you or a loved one is struggling with substance abuse and addiction, Hazelden Betty Ford counselors and addiction treatment professionals are here for you. With outpatient and residential programs throughout the country, we offer every patient the best chance of lifelong recovery. For more information, call 1-866-831-5700.

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