Due to its massive negative impact on the quality of life, insomnia encourages drug-based treatment. In some instances, such an approach is fully justified. In other cases, however, it is entirely misguided. It ends up doing more harm than good. One drug that unfortunately lends itself well to anti-insomnia use is trazodone. Trazodone is an anti-depressant. Its off-label use for insomnia is more popular however than its approved use.
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In this article, we take a look at why you should not use trazodone for sleep. Under certain circumstances, this drug might be the solution to your sleep-related problems. Unless a sleep specialist prescribes it to you, however, you should steer clear of it.
What is Trazodone? How Does it Work?
Trazodone is an FDA-approved drug for the treatment of depression. It is currently not approved for the treatment of insomnia. That said, its off-label use for this purpose is widespread.
What you should know about off-label medicine use is that it is not uncommon at all. Doctors routinely make such prescriptions. They do so being fully aware of the pharmacology of the prescribed drug.
The Pharmacology of Trazodone
The pharmacology of this drug explains why so many doctors prescribe it for insomnia. If you are at all interested in dreaming and sleep in general, you will probably find it very interesting.
A 2017 systematic review, by Tiffany Chang, Brigitte Vanle, Karim Yahia Jaffer, et al., on the use of trazodone for insomnia, took a close look at the pharmacology of the drug.
Approved in 1982 for the treatment of depression, trazodone is a triazolopyridine derivative. It acts upon the neurotransmitter serotonin. Its action is a double-pronged one.
On the one hand, it is a serotonin antagonist, meaning that it mimics the effects of the neurotransmitter. On the other hand, it also inhibits serotonin reuptake. From the perspective of insomnia, it is also significant that trazodone impacts the cortisol suppression of the hypothlamic-pituitary-adrenal axis.
The main pharmacological action of trazodone is serotonin receptor blocking. That said, the mentioned study concludes that science does not currently understand everything about its mechanism of action.
As mentioned, despite its popularity, trazodone is far from an ideal solution for insomnia. Those who use it to this end face several mild and serious side effects. Some of these side effects are:
- Mind fog.
- Dry mouth.
- Nasal congestion.
- Coordination issues.
Some side effects are more severe than the above. These include:
- Hair loss.
- Considering self-harm (mostly in teenagers and children).
- Urinary retention.
- Blood in the urine.
- Abdominal pain.
- Reduced libido.
- Ejaculation problems.
- Painful erections.
- Some physical dependence.
- Panic attacks.
If the above side effects are not enough to dissuade you from using trazodone as a sleep aid, consider the following: trazodone’s side effects include insomnia and anxiety. This is contradictory, as the drug is used to combat these two conditions among others.
The bottom line is that trazodone use may promote the very problems you are trying to solve with it. What is worse still is that the above lists do not cover all possible trazodone side effects.
As to the discomfort and danger, these side effects entail, some are obvious, others less so. At any rate, it is safe to conclude that you should not drive a vehicle while under the effect of trazodone.
If you are a multiple health condition sufferer, you open yourself up to more risks by using trazodone for insomnia. The drug interacts with a high number of other medications. Some of these interactions can be fatal. Your doctor understands these risks and knows how to avoid drug interactions. This is why it is important to never use drugs like trazodone on a whim.
- Monoamine oxidase (MAO) inhibitors can interact with trazodone in a potentially fatal manner, according to WebMD. You should avoid taking any MAO inhibitors while using trazodone. Stop using MAO inhibitors at least two weeks before beginning a trazodone treatment. Also, do not take such drugs until at least two weeks have elapsed following the end of your trazodone treatment.
- Antifungals like ketoconazole (the main active ingredient of some anti-dandruff shampoos) alter the way trazodone is eliminated from your body. Thus they also alter the way it works.
- Other drugs with which trazodone interacts are macrolide antibiotics, seizure drugs, and HIV protease inhibitors.
- As mentioned, trazodone does plenty to increase serotonin levels in and of itself. If it is somehow mixed with another serotonin-promoting drug, it runs the risk of causing serotonin syndrome.
- You should tell your doctor about all other medications that you receive. Do not fail to mention drowsiness-causing substances, such as alcohol, marijuana, and antihistamines.
Trazodone for Sleep & Depression: Dosages
For insomnia, doctors prescribe relatively low doses of trazodone. To achieve its main pharmacological action, 1 mg of trazodone is enough. 50 mg doses also bring the antagonism angle into the picture.
This is a starter-dose for sleep-related problems. Some doctors will prescribe doses are large as 100 mg for sleep.
To achieve full anti-depression effects, larger doses of trazodone are required. The starting dose for depression is 150 mg. Doses as large as 600 mg may be used.
According to rxlist.com, the largest dose for an adult outpatient is 400 mg. Only adult inpatients may receive doses of 600 mg.
Children and the elderly receive smaller doses for sleep as well as for depression.
We should perhaps point out that trazodone has other off-label uses besides fighting insomnia.
Some doctors turn to it to address:
- Aggressive behavior. Dosage starts at 50 mg and goes all the way to 400 mg.
- Cocaine withdrawal. Up to 200 mg per day.
- Alcohol withdrawal. Up to 600 mg per day.
- Migraine prevention. Dosages to this end are around 100 mg per day.
All the above are off-label uses. Please note that you should always take this drug with food.
Effectiveness of Trazodone for Sleep
Scientists have found trazodone’s efficacy for insomnia to justify its off-label use as a sleep aid. That said, they have come up with a few interesting conclusions.
A 2019 study by the Department of Psychiatry of the Tel Aviv Sourasky Medical Center, found that trazodone exerted an effect on the mu and delta subtype opioid receptors. The study concluded that this opioid profile is probably key to the anti-insomnia effects of the drug.
In some regards, this is good news, in others, less so. This information means that trazodone does carry a potential for abuse.
Is Trazodone Addiction a Problem?
Antidepressants such as trazodone are potential substances of abuse. Granted, this class of medicines is not the most likely to be abused. Still, the potential is there. Even trazodone has been abused by some users, who decided to snort it instead of taking it orally.
In a 1999 study, by Rush CR, Baker RW, and Wright K of the University of Mississippi Medical Center, Jackson, the addiction potentials of three drugs were compared.
Zolpidem and triazolam “bested” trazodone in this regard. Still, the study acknowledged that the potential for abuse exists in trazodone’s case as well.
How exactly do people abuse trazodone?
A 1994 study by Joyce A Tinsley, Mark W Olsen, and others, of the Department of Psychiatry and Psychology of the Mayo Clinic in Rochester, presented two case reports, at least one of which involved trazodone abuse.
The subject was a 30-year old male, with a history of heavy and prolonged substance abuse. This person used fluoxetine as a substitute for “speed” and trazodone as a substitute for alcohol. His attempts to mimic his previous drug “regimen” through these substances were successful. At least to the point when they landed him in the hospital with intoxication.
The snorting of trazodone is another relatively popular path of abuse. This type of administration is contrary to medical instructions. Why do people resort to it? It hastens uptake and intensifies the effects of sedation produced by the drug. It is safe to assume that those who take trazodone this way do not use it for medical reasons.
Trazodone use will result in mild physical dependence. What this means is that users will experience withdrawal symptoms when they discontinue use. These symptoms may include:
- Flu-like symptoms.
Who Are the People Most Likely to Abuse Trazodone?
Based on scientific evidence detailed above, we can conclude that the people most likely to resort to trazodone abuse are those with a history of substance abuse. In abuse cases, trazodone is most often used in conjunction with other drugs.
Another category of trazodone users likely to commit abuse is that of people who take prescription drugs for non-medical reasons.
Some Signs of Possible Trazodone Addiction
People abusing drugs go through some typical activities which can betray their addiction. A trazodone addict may:
- Get the drug without a prescription. He/she may also go through an unusual amount of trouble just to get trazodone.
- Combine trazodone with other drugs or alcohol. Due to its sensitive interaction profile, trazodone is seldom prescribed in conjunction with other drugs.
- Attempt to get more of the drug than prescribed by the doctor.
- Use the drug for other than its approved- or accepted off-label purpose.
- Have a strong reaction to trazodone deprival.
- Exhibit several of trazodone’s severe side effects, yet continue taking the drug.
What Do Users Say About Trazodone for Sleep?
While some people react to trazodone in-line with expectations, others do not tolerate it. Feedback on the effects of the drug is plentiful and diverse.
According to feedback at drugs.com, taking trazodone for insomnia carries some significant risks.
The number of people who find the drug useful for treating the condition is roughly equal to the number of those who have reported severe side effects.
Some people are so sensitive to the drug that even a single pill will temporarily upend their lives.
One person has reported feeling “generally lousy” after taking a 100 mg dose. He/she has described the effects as being akin to coming down with the flu. It is also unclear whether, in that instance, the drug had any effect on sleep. The following day, the said patient, reported brain fog and a general feeling of sickness.
Even people who gave the drug a high mark efficacy-wise reported severe side effects. One such patient said that while it worked for sleep, it also gave him/her anxiety, headaches, dizziness, and dry mouth. This person only took 25 mg doses of the drug.
According to another bit of feedback, trazodone is useful for sleep. It can knock a person out, but the following day its side-effects take center stage. You should be prepared for feeling groggy all day and having a slight headache that does not go away.
Some people do not see any sleep-wise benefits from trazodone. One user complained that within minutes of having taken the drug, his/her nose clogged up. He/she then had to breathe through the mouth. The result was no sleep and a menagerie of very unpleasant side effects.
Yet another user opined that if you take trazodone, you should plan on not doing anything the following day.
Scary experiences have been noted as well. A user, who took trazodone together with Ambien, as prescribed by his/her doctor, reported terrible sleep interspersed with vivid nightmares. Some symptoms of serotonin overload can indeed be scary.
Other user-reported side effects of trazodone include bloating and weight gain. According to a feedback-provider, someone ended up gaining 30 lbs due to trazodone.
With long-term use, some of the negative side effects of the drug become more pronounced. Stopping altogether for a while is what some users have recommended.
In addition to irksome side-effects, some users have reported spotty effectiveness. The drug would help them sleep for 3-4 nights, and then it would fail for the following 3-4 nights.
For some users, not only did trazodone not work for sleep. It seemed to have the opposite effect of keeping them awake.
One user has complained about “almost dying.” Trazodone lowered his/her blood pressure too much.
For some users, trazodone turned out to be a temporary remedy to insomnia. It reportedly stopped working after a few weeks.
The Bottom Line on Trazodone for Sleep
The drug might work for some insomnia sufferers, but it seems to elicit some terrible side effects. Even those who claim it works for them, have complained of side effects.
If you are an average person, struggling with occasional bouts of insomnia, you should probably look past trazodone.
Try to get your sleep hygiene into shape instead.
- Do not watch TV in bed.
- Do not exercise late at night.
- Simmer down before bedtime.
- Avoid alcohol and smoking.
- Try to be consistent with your bedtime.
If your insomnia persists, get in touch with me and we’ll try to uncover why that is the case. Pinpoint reasons. Address them.
Even if it comes to taking sleeping pills, there are many options out there, better than trazodone.