The pharmaceutical drug trazodone is a commonly prescribed antidepressant that is also used off-label as a sleep aid to help you fall asleep. It has been used as a sleeping pill for decades, but how does trazodone work? How well, on average, does it help you fall asleep or get more sleep at night? What are the common side effects?
Find out if trazodone is right for you and what alternatives might be helpful, including needing a sleep test if chronic insomnia persists.
Trazodone is an older drug that has been used for many years to treat severe depression and anxiety. Because it has a sedative or hypnotic effect, that is, it causes drowsiness, it is also useful in the treatment of insomnia or acute insomnia .
It is not known exactly how trazodone works. What is known is that it acts on neurotransmitters, which are chemical messengers in the brain. It allows a certain neurotransmitter called serotonin to accumulate in the spaces between nerve cells, blocking their absorption by neighboring cells.
It also interacts with histamine (and antihistamines like diphenhydramine are well known as hypnotics). These effects seem to combine to improve slow sleep (or N3) .
The American Academy of Sleep Medicine does not currently recommend the use of trazodone for the treatment of insomnia, suggesting that the potential risks and harms outweigh the benefits .
This is based on research suggesting that the time it takes to fall asleep is only reduced by an average of 10 minutes with trazodone compared to placebo. Also, with the help of trazodone, the duration of nighttime wakefulness is reduced by an average of just eight minutes.
Precautions and contraindications.
If you decide to use trazodone, some people should reconsider its use. Trazodone should not be used in people recovering from a heart attack.
In addition, it should not be used by people under 25 years of age, and the elderly should use the drug with caution. You should avoid taking trazodone if you are pregnant or breastfeeding.
Trazodone may also not be suitable for people with mental illnesses, including bipolar illness and schizophrenia, or those at risk of suicide. Use trazodone with caution if you have heart or cerebrovascular disease, seizures, or kidney or liver problems.
Trazodone can interact with many other medications, so your healthcare provider should take your medications carefully before you start taking trazodone. No deaths or heart complications have been reported in people taking trazodone alone. Abrupt discontinuation of medication should be avoided; instead, a narrowing may be required under medical supervision.
Any drug has many potential side effects.
While a person is not expected to experience most of the side effects (and, in fact, may not have any of them), some of them that can commonly occur with trazodone include :
- Dry mouth
- Blurry vision
- Nausea or vomiting
- Low blood pressure
- Skin reactions such as a rash.
- Muscle pains
- Weight changes
- Trembling (trembling)
- Problems walking or coordination of movements.
There is also the risk of serious side effects with any drug. This happens less frequently. When using trazodone, they may include :
- Priapism (persistent painful erection)
- Orthostatic hypotension (low blood pressure when standing)
- Abnormal heart rhythms
- Hypertension (high blood pressure)
- Myocardial infarction
- Extrapyramidal symptoms
- Tardive dyskinesia
- Hypomania / mania
- Exacerbation of psychosis
- Worsening depression
- Suicidal thoughts
- Neutropenia (low white blood cell count)
- Hepatitis (inflammation of the liver)
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
As noted above, some people should use this drug with caution or not take it at all. It is important to be supervised by your healthcare provider when you start taking a medicine or make dose changes. In particular, watch for symptoms of suicidal behavior or unusual changes in behavior.
If you have any difficulties, you should keep in close contact with your primary healthcare provider. If insomnia persists, consider treating it with cognitive behavioral therapy for insomnia (CBTI) . You can use the Provider Discussion Guide below to start a conversation with your doctor.
A Discussion Guide for a Healthcare Provider for Insomnia
Get our printed guide to your next doctor's appointment to help you ask the right questions.
Get the word of drug information
If you find that insomnia has reigned, prompting you to consider using sleeping pills, including prescription drugs like trazodone, consider having it examined by a board-certified sleep therapist. Sleep disorders, including sleep apnea, can generally contribute to sleep disturbances at night.
Treating this condition can help relieve insomnia. Additionally, conditions such as sleep apnea can undermine the effectiveness of medications and lead to long-term effects if left untreated or masked with medications. Fortunately, effective treatment can lead to improvement by avoiding the constant need for potentially harmful medications.