What is Trazodone?

Trazodone is a prescription medication approved for use by the Food and Drug Administration (FDA) as an antidepressant and sedative medication. It works by helping to restore and maintain the balance of a natural chemical in the brain called serotonin, which may be unbalanced in people with depression.

Trazodone is approved by the FDA for the treatment of major depressive disorder, helping people with depression improve their mood, appetite, and energy level as well as decreasing anxiety. However, trazodone can also be prescribed as a sedative drug for the treatment of insomnia (depression-related or otherwise) and is one of the most commonly prescribed medications for insomnia.

Trazodone as a sleep aid

For many patients, the drug has a sedative effect even at low doses, inducing a relaxed, sleepy feeling by blocking chemicals in the brain that interact with serotonin and other neurotransmitter and histamine receptors. For this reason, it’s considered a good alternative to more strictly controlled substances like Ambien, Lunesta, or even benzodiazepine drugs like Xanax or Restoril.

In prescribing the drug for sleep disorders, physicians typically recommend taking a low dose at bedtime in order to limit the effects of drowsiness, and even at these low doses, many people still report lingering effects like sluggishness and fatigue, particularly right after waking up.

How does Trazodone work?

Trazodone works by increasing the availability of the neurotransmitter serotonin in the central nervous system and is categorized as a serotonin antagonist reuptake inhibitor (SARI), meaning that it can block neurons from reabsorbing serotonin once it has been released. This leaves the neurotransmitter available in the brain for longer periods of time, which should help with issues related to depression.

While all antidepressant medications are designed to affect brain chemistry, various pharmaceutical formulations of the drugs have different targets and paths. Antidepressants are generally divided into three types: selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and norepinephrine and dopamine reuptake inhibitors (NDRIs). Because trazodone doesn’t fit any of these specific categories, it’s commonly classified as an atypical antidepressant and a serotonin modulator.

Off-label prescribing

Due to Trazodone’s unusual chemical composition, it’s considered less effective than other antidepressants for the treatment of depression. As a result, Trazodone is actually more commonly prescribed as a sleep aid than as an antidepressant medication.

The FDA approves medications to treat specific conditions, but doctors can prescribe medications for conditions other than what was approved by the FDA based on their experience and judgment, which is known as off-label prescribing. Off-label prescribing is a widespread practice, and as much as 20 percent of drugs are prescribed this way.

Trazodone is sometimes prescribed off-label for the following:

  • Cocaine withdrawal
  • Alcohol withdrawal
  • Prevention of migraine
  • Complex regional pain syndrome
  • Obsessive-compulsive disorder (OCD)
  • Schizophrenia as an adjunct to improve negative symptoms.
  • Erectile dysfunction

Trazodone side effects and dangers

Like most prescription medications, Trazodone may cause side effects even when taken as prescribed. The most common side effects of Trazodone 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
  • 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)
  • Weight gain or loss

Trazodone overdose

There have been reports of overdose with trazodone use. These risks are higher with drinking alcohol, taking benzodiazepines, and other central nervous system depressant drugs that can slow your breathing and reactions.

Trazodone overdose symptoms include:

  • Chest pain
  • Shortness of breath/trouble breathing
  • Slowed heart rate
  • Fast or irregular heartbeat
  • Priapism
  • Fainting
  • Coma
  • Seizures

Serotonin syndrome

One of the risks associated with abusing antidepressants such as Trazodone is a condition called serotonin syndrome, which occurs when high levels of serotonin accumulate in the body.

Clinical symptoms of serotonin syndrome can develop within two hours—or up to 24 hours—after taking an increased dose or combining antidepressant drugs.

Signs and symptoms of serotonin syndrome include:

  • Tremors
  • Muscle aches
  • Sweating
  • Anxiety
  • Confusion
  • Rapid heart rate
  • Delirium
  • Hallucinations
  • Seizures
  • Kidney failure
  • Death

Risk of Suicidal Thoughts

Like many antidepressants, trazodone has been issued a “Black Box Warning” by the FDA.

Trazodone may increase the risk of suicidal thoughts and behaviors in children and young adults (under the age of 24) and is not approved for use with pediatric patients. People taking this medication should be closely monitored for worsening symptoms and emergence of suicidal thoughts and behaviors.

Potential for abuse

While trazodone is often prescribed for insomnia as an alternative to medications like benzodiazepines and hypnotics that are known to have a higher potential for abuse, it can still cause physical dependence, especially when it is misused and/or taken in higher doses.

Although it is not a common primary drug of abuse, there are many reports of individuals snorting Trazodone to intensify its sedating the facts and speed up the onset of action for recreational purposes. It may also be used in combination with other drugs, such as prescription narcotics or alcohol, which can also intensify its effects.

Trazodone abuse and addiction signs

Any use of Trazodone outside of a doctor’s instructions is considered drug abuse. This includes tampering with pills by chewing, crushing, cutting or dissolving them in order to ingest, snort or inject a higher dose than prescribed. Even if the pills are not tampered with, taking more pills than prescribed is also considered abuse of the drug.

Trazodone addiction signs include:

  • Taking more than the prescribed dosage
  • “Doctor shopping” for multiple prescriptions
  • Tampering with it before taking it
  • Mixing it with other sedatives or alcohol

Trazodone dependence and withdrawal

Trazodone use does lead to physical dependence, and abruptly discontinuing use can cause those taking the medication to experience uncomfortable withdrawal symptoms. While taking Trazodone, the brain responds to the increased amount of serotonin by reducing the number of serotonin receptors. When a person stops taking the drug, the decreased volume of receptors creates a short-term deficiency of serotonin activity. While the brain will typically correct this on its own over time, one may experience uncomfortable withdrawal symptoms during the adjustment period.

In order to avoid these unpleasant withdrawal symptoms, people may continue to use Trazodone even if it is no longer needed. In extreme cases, those with a dependency or addiction will even visit different doctors for more prescriptions or purchase it illegally.

Rather than stopping the medication immediately, 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

Depression and dual-diagnosis treatment

Due to the way Trazodone affects brain chemistry and because it is often prescribed to treat depression in the first place, many people experience symptoms of depression when discontinuing the medication. That’s why the best treatment approach treats substance use and any co-occurring psychological disorder at the same time, known as dual diagnosis treatment.

Enterhealth’s dual diagnosis capabilities provide us greater insight into the cause-and-effect relationship between medications and psychological disorders. Our team of MDs, psychiatrists, psychologists, and Master’s-Level Therapists work in tandem to diagnose and treat disorders such as:

  • Major depression
  • Anxiety
  • Bipolar (manic depression/ mood swings)
  • Personality disorders
  • Psychosis
  • Sleep disorders
  • Suicidal thoughts
  • PTSD/Traumatic experiences
  • Eating disorders, including weight-loss surgery patients

Trazodone addiction treatment though Enterhealth

Enterhealth Ranch – our 43-acre inpatient rehab program just north of Dallas-Fort Worth in Texas – provides supervised drug and alcohol detox (also known as withdrawal stabilization) services for Trazodone addiction, which includes science-based medication therapy administered and overseen by onsite medical staff. Enterhealth Ranch offers specialized psychological counseling and therapeutic modalities, with treatment plans designed by a team of addiction experts and customized to fit the unique needs of each patient.

Patients can also get treatment through The Enterhealth Outpatient Center of Excellence, our outpatient facility in the Park Cities area of Dallas, where they can receive medically supervised addiction treatment while living at their own residence. Our comprehensive services – which form a continuum of care – provide patients with the education, resources, and ongoing counseling and support they need to achieve a sustained recovery.

At Enterhealth, our goal is to treat the whole person for a lifetime. We offer a better chance to recover through our advanced, evidence-based treatment approach, which is designed and administered by board-certified addiction psychiatrists, physicians and other experts and proven to be more effective than traditional 12-step approaches.