Trazodone For Insomnia - Evidence, Dosage, Side Effects, and More

Trazodone For Insomnia

The following article is a summary of current evidence and information about taking Trazodone for depression. 

Insomnia is the difficulty of falling asleep or staying asleep for long enough throughout the night to feel refreshed the next morning.

Trazodone is classified as an atypical antidepressant medication and belongs to the group of serotonin-antagonist-and-reuptake-inhibitor class of medication. 

The information in this article is not intended as individual medical advice. Consult with your psychiatrist. Do not take any medicines unless they have been discussed with your medical doctor.

Evidence

• Trazodone is FDA-approved for the treatment of major depressive disorder, but not for the treatment of insomnia. However, it is not uncommon for physicians to prescribe off-label Trazodone for sleep disorders.
  
  
• The main mechanism through which Trazodone promotes sleep is its antagonistic effect on 5-HT2 serotonin receptors, increasing the duration of deep sleep.
  
  
• A 2017 systematic review looking at 45 studies demonstrated that Trazodone is an effective option in the treatment of both primary and secondary insomnia, including in individuals with depression, dementia, and those who are otherwise healthy.
  
  
• Overall, the literature supports the efficacy and safety of using Trazodone for insomnia at low doses.

Treatment with Trazodone for Insomnia

• The recommended starting dosage when using Trazodone for insomnia is 25-50 mg, which can be increased up to 100 mg.
  
  
• This is unlike using Trazodone for the treatment of depression, where dosages are usually between 150-300 mg per day and administered twice a day, because of its relatively short half-life. 
  
  
• Trazodone should be administered before bedtime when used for sleeping disorders.

Side Effects of Trazodone

• Common adverse effects include drowsiness, dizziness,  gastrointestinal discomfort, headaches, fatigue, QT-prolongation, tachycardia, and orthostatic hypotension. 
  
  
• There have also been reported cases of palinopsia and visual hallucinations, in which case the medication should be discontinued. 
  
  
• Trazodone may in rare cases cause priapism, a medical emergency where an erection lasts longer than 4 hours.
  
  
• Like all other FDA-approved antidepressants, Trazodone has a black box warning due to the increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults.

Contraindications

• Allergy or hypersensitivity to Trazodone.
  
  
• Current use of any MAO inhibitor drugs or if you have been taking them within the last 14 days. 
  
  
• The use of Trazodone requires caution in patients with compromised liver and/or renal function.

Useful Information

• Trazodone has not been found to cause addiction, unlike regularly prescribed Z-drugs, such as Zolpidem (Ambien) or Zopiclone (Imovane). Moreover, Trazodone promotes better sleep quality by increasing deep sleep duration, in contrast with Z-drugs that decrease slow-wave activity and act on GABA-A receptors.
  
  
• Trazodone uniquely inhibits SERT, 5-HT2A, and 5-HT2C receptors, which distinguishes it from SSRIs and SNRIs and due to which it may not cause sexual dysfunction, insomnia, and anxiety frequently associated with more classical antidepressants.
  
  
• Older adults are particularly prone to suffer from orthostatic hypertension as an adverse effect of Trazodone, hence the dosage should be kept as low as possible. Administering Trazodone after a meal may reduce lightheadedness and postural hypotension.

Photo by Andrea Piacquadio at Pexels.com

Author: J. Martin, M.D. 
Last updated: July 14, 2023

Disclaimer: The information provided is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as a physician, before starting any new treatment or making changes to your existing treatment plan. Individual responses to treatment may vary, and a healthcare professional can provide personalized guidance based on your specific needs and circumstances. If you are experiencing severe or persistent symptoms of disease or mental illness, seek immediate medical attention.