Many people struggle with getting a good night's sleep, and sometimes prescription medication is considered. Trazodone, an antidepressant, is frequently prescribed for insomnia, especially in the United States. It's used "off-label" for this purpose, meaning it's prescribed for a condition it wasn't originally approved to treat.
This article will look at what trazodone is, how it might help with sleep, and what you should know if you're considering it.
At a Glance
Trazodone is an antidepressant that is often prescribed as a sleep aid, though it's not FDA-approved specifically for insomnia.
It works by affecting serotonin and other brain chemicals, which can lead to drowsiness.
While it's common in the US, some guidelines do not recommend it as a first-line treatment for insomnia due to limited evidence of its effectiveness and potential side effects.
Common side effects can include drowsiness, dry mouth, and blurred vision, but more serious risks like suicidal thoughts, serotonin syndrome, and priapism can occur.
Trazodone is often chosen because it's less expensive than some other sleep medications and is not considered addictive, but alternatives with stronger evidence bases for insomnia treatment are available.
What is Trazodone?
Trazodone is a medication originally developed and approved by the U.S. Food and Drug Administration (FDA) as an antidepressant. It has been available since 1981\.
While its primary indication is for treating major depressive disorder in adults, it is frequently prescribed for insomnia, a use that is considered off-label. This means the drug is used for a condition other than what it was specifically approved for by the FDA. This practice is quite common in medicine, with a significant percentage of medications being prescribed in this manner.
Trazodone is available under various brand names, including Desyrel and Oleptro, and also as a generic medication, which can make it a more accessible option for some individuals. Its use for sleep is particularly prevalent in the United States, though its recommendation for insomnia varies among different medical guidelines and countries.
For instance, while widely used in the U.S., some professional organizations, like the American Academy of Sleep Medicine, do not recommend it as a first-line treatment for insomnia.
The drug works by affecting certain chemicals in the brain, specifically neurotransmitters like serotonin. Its impact on serotonin pathways, along with its effects on other brain receptors, contributes to its sedative properties.
How Trazodone Works for Insomnia
Trazodone affects levels of neurotransmitters, which are brain chemicals that send signals. Specifically, it impacts serotonin, a chemical linked to mood and sleep. While higher doses of trazodone are used to treat depression by increasing serotonin, lower doses used for insomnia are believed to work differently.
Serotonin Receptor Activity: Trazodone acts as a serotonin 5-HT2A receptor antagonist. By blocking these receptors, it may reduce the stimulating effects of serotonin, leading to increased sleepiness.
Histamine Blockade: Trazodone also has antihistamine properties. Blocking histamine receptors in the brain can promote sedation and reduce wakefulness.
Alpha-1 Adrenergic Blockade: The drug can also block alpha-1 adrenergic receptors. This action might contribute to its sedative effects, though it can also be associated with side effects like dizziness or low blood pressure.
The combination of these actions is thought to contribute to trazodone's ability to induce sleep. At the lower doses typically used for insomnia, the sedative effects are more prominent than the mood-lifting effects associated with higher antidepressant doses.
This allows individuals to fall asleep more easily without necessarily experiencing the full antidepressant effects or significant daytime grogginess, although drowsiness can still occur.
Effectiveness of Trazodone for Insomnia
Trazodone is frequently prescribed for insomnia, but its effectiveness is a topic with mixed findings in neuroscience research. Some studies suggest it can help with sleep, while major sleep organizations have raised concerns about the evidence supporting its use.
Here's a look at what the research indicates:
Studies Showing Some Benefit: A few studies have pointed to potential benefits. For instance, one small study in patients with Alzheimer's disease found that trazodone, at a dose of 50 mg, increased total sleep time and improved sleep efficiency compared to a placebo.
However, these patients also received sleep hygiene education, which could have influenced the results. Another small trial suggested trazodone might lengthen total sleep time more than cognitive behavioral therapy for insomnia (CBT-I) in patients with short sleep duration, though it didn't improve insomnia severity scores.
Concerns and Lack of Strong Evidence: On the other hand, major organizations like the American Academy of Sleep Medicine (AASM) have reviewed the available evidence and concluded that there isn't enough strong support to recommend trazodone for chronic insomnia. They noted a lack of robust efficacy studies and some evidence of potential harm.
Similarly, a Cochrane review found only moderate improvements in sleep outcomes compared to placebo, with little difference in sleep quality, and insufficient evidence for its recommendation. This review also noted low-quality evidence suggesting more adverse effects with trazodone than placebo, such as morning grogginess and dry mouth.
Expert Opinions: Reflecting the mixed evidence, expert panels have also had differing views. While some healthcare professionals may use trazodone, a majority view among some expert panels has been that it's not a preferred first-line treatment for insomnia due to the limited evidence of effectiveness and potential side effects.
Overall, while trazodone might offer some sleep benefits for certain individuals, the scientific consensus from major sleep medicine bodies is that the evidence for its effectiveness in treating chronic insomnia is not strong enough to warrant a general recommendation.
Dosage and Administration
Typical Dosing for Insomnia
Doses can vary significantly based on individual patient needs and response.
Lower doses, often around 50 mg, are frequently used as a starting point for insomnia. Some sources suggest this dose can aid in falling asleep, staying asleep, and increasing sleep duration.
Doses may be adjusted by a healthcare provider based on how a person responds to the medication.
Higher doses are generally reserved for treating depression and may lead to increased side effects, including daytime drowsiness.
When to Take Trazodone
Trazodone is typically taken shortly before bedtime. The exact timing can depend on the specific formulation and the healthcare provider's instructions. Because it can cause drowsiness, it is important to take it only when ready to sleep and to avoid activities requiring alertness until the effects of the medication have worn off.
It is generally not recommended for use in children and young adults due to an increased risk of suicidal thoughts and behaviors, a concern highlighted by an FDA "Black Box Warning" for antidepressants.
Potential Side Effects and Risks
While trazodone can be helpful for sleep, it's important to be aware of its potential side effects and risks. Like any medication, it doesn't work the same for everyone, and some people might experience unwanted effects.
Common Side Effects
Many people tolerate trazodone well, but some common side effects can occur. These often lessen as your body adjusts to the medication. They can include:
Drowsiness or feeling sleepy during the day
Dizziness
Dry mouth
Blurred vision
Constipation
Nausea
Serious Side Effects and Precautions
Although less common, some serious side effects can happen. One notable risk associated with trazodone is priapism, which is a prolonged and often painful erection that is not related to sexual stimulation. This is a medical emergency that requires immediate attention to prevent permanent damage.
Other serious side effects to be aware of include:
Serotonin Syndrome: This is a potentially life-threatening condition that can occur when there are high levels of serotonin in the body. Symptoms can include agitation, hallucinations, rapid heart rate, fever, and muscle stiffness. It is more likely to occur when trazodone is taken with other medications that affect serotonin levels, such as certain antidepressants.
Suicidal Thoughts or Behavior: As with some other antidepressants, there is a risk of increased suicidal thoughts or behaviors, particularly in younger adults. Close monitoring is advised, especially when starting the medication or changing the dose.
Heart Rhythm Changes: Trazodone can sometimes affect the heart's electrical activity, leading to irregular heartbeats. This risk is higher in individuals with pre-existing heart conditions.
Low Blood Pressure (Hypotension): Some individuals may experience a drop in blood pressure, leading to dizziness or fainting, especially when standing up quickly.
Anyone experiencing these serious side effects should seek medical help immediately. It is also important for healthcare providers to screen patients for conditions that might increase their risk of adverse events and to counsel them on potential issues before prescribing trazodone.
Trazodone vs. Other Sleep Medications
When considering trazodone for sleep, it's helpful to see how it stacks up against other options.
One notable difference is trazodone's potential cost-effectiveness. Because it's available as a generic drug, it can sometimes be less expensive than newer, branded sleep medications.
Furthermore, trazodone is generally not considered to have the same addictive potential as some other classes of sleep drugs, such as benzodiazepines. For individuals concerned about dependence, this can be a significant factor.
However, it's important to note that the evidence supporting trazodone's effectiveness for insomnia is not as robust as for some other treatments. This contrasts with treatments like CBT-I, which has a strong evidence base, or certain FDA-approved insomnia medications that have undergone extensive clinical trials specifically for sleep disorders.
Here's a general comparison:
Trazodone:
Antidepressant with off-label use for insomnia.
Generally not considered addictive.
May be more affordable.
Evidence for efficacy in insomnia is mixed and not as strong as for other treatments.
Potential for side effects, including daytime drowsiness.
FDA-Approved Insomnia Medications:
Specifically developed and approved for treating insomnia.
Have undergone rigorous clinical trials demonstrating efficacy and safety for sleep disorders.
May have varying mechanisms of action and side effect profiles.
Can carry risks of dependence or withdrawal symptoms.
A non-pharmacological approach focusing on behaviors and thoughts related to sleep.
Considered a first-line treatment by many sleep experts.
Has a strong evidence base for long-term effectiveness.
Does not involve medication and has minimal side effects.
Ultimately, the choice of sleep medication involves weighing potential benefits against risks and considering the available evidence for each option. Trazodone may be considered when other treatments have not been successful or when specific patient factors, like cost or concerns about addiction, are prominent.
Conclusion
So, what's the final word on trazodone for insomnia? While it's a common go-to, especially in the U.S., and can be inexpensive and not seen as addictive, the medical community is divided.
Major sleep organizations, like the American Academy of Sleep Medicine, don't recommend it as a first choice for chronic insomnia due to a lack of strong evidence showing it's consistently effective and safe for this specific use. The potential for side effects, though often mild like drowsiness, exists, and more serious risks, though rare, are possible.
It's really important to talk to your doctor about your sleep issues. They can help you figure out the best path forward for your brain health, which might involve lifestyle changes, behavioral therapies like CBT-I, or other medications that have more solid research behind them for treating insomnia. Trazodone might be an option for some people, but it's not a one-size-fits-all solution and should be considered carefully with professional guidance.
References
Pelayo, R., Bertisch, S. M., Morin, C. M., Winkelman, J. W., Zee, P. C., & Krystal, A. D. (2023). Should Trazodone Be First-Line Therapy for Insomnia? A Clinical Suitability Appraisal. Journal of clinical medicine, 12(8), 2933\. https://doi.org/10.3390/jcm12082933
La, A. L., Walsh, C. M., Neylan, T. C., Vossel, K. A., Yaffe, K., Krystal, A. D., Miller, B. L., & Karageorgiou, E. (2019). Long-Term Trazodone Use and Cognition: A Potential Therapeutic Role for Slow-Wave Sleep Enhancers. Journal of Alzheimer's disease : JAD, 67(3), 911–921. https://doi.org/10.3233/JAD-181145
Vgontzas, A. N., Puzino, K., Fernandez-Mendoza, J., Krishnamurthy, V. B., Basta, M., & Bixler, E. O. (2020). Effects of trazodone versus cognitive behavioral therapy in the insomnia with short sleep duration phenotype: a preliminary study. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 16(12), 2009–2019. https://doi.org/10.5664/jcsm.8740
Melo, F. L., Mendoza, J. F. W., Latorraca, C. O. C., Pacheco, R. L., Martimbianco, A. L. C., Pachito, D. V., & Riera, R. (2018). What do Cochrane systematic reviews say about interventions for insomnia?. Sao Paulo medical journal \= Revista paulista de medicina, 136(6), 579–585. https://doi.org/10.1590/1516-3180.2018.0380311018
Frequently Asked Questions
What exactly is Trazodone?
Trazodone is a type of medicine that was originally created to help with depression. It belongs to a group of drugs called antidepressants. However, it's also frequently used to help people sleep better, especially in the United States.
How does Trazodone help with sleep?
Trazodone works by affecting certain chemicals in your brain, like serotonin. It can make you feel sleepy by blocking certain signals that keep you awake. It also affects other brain chemicals that can influence mood and sleep patterns.
Is Trazodone a recommended treatment for insomnia?
While many doctors prescribe Trazodone for sleep, it's not always considered a top choice. Some major sleep organizations suggest it shouldn't be the first medication tried for long-term sleep problems because there isn't strong proof it works best for everyone. Other treatments might be preferred first.
What are the typical doses of Trazodone for insomnia?
When used for sleep, Trazodone is usually given in smaller amounts than when it's used for depression. Doses often start around 50 mg to 100 mg taken before bedtime. Your doctor will decide the right amount for you.
When should I take Trazodone for sleep?
It's best to take Trazodone shortly before you plan to go to sleep. This allows the medication to start working when you're ready to rest. Always follow your doctor's specific instructions.
What are the common side effects of Trazodone?
Some people might feel drowsy or sleepy during the day, have a dry mouth, or experience headaches. These are some of the more common effects. It's important to tell your doctor about any side effects you notice.
Are there any serious risks associated with Trazodone?
Yes, though rare, serious side effects can occur. These include very painful erections that don't go away (priapism), irregular heartbeats, and in some cases, an increased risk of suicidal thoughts, especially in younger people. It's crucial to seek medical help immediately if you experience severe reactions.
Can I stop taking Trazodone suddenly?
It's generally not recommended to stop taking Trazodone abruptly. Your body may have gotten used to it, and stopping suddenly could lead to withdrawal symptoms. It's best to talk to your doctor about gradually lowering the dose if you need to stop.
Emotiv is a neurotechnology leader helping advance neuroscience research through accessible EEG and brain data tools.
Emotiv
