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Updated on June 16, 2022

Trazodone - Risks, Side Effects, Addiction, and Treatment

What is Trazodone?

Trazodone is a generic antidepressant prescription medication. It is approved by the Food and Drug Administration (FDA) for the treatment of depression.

Health care practitioners also use it for insomnia and mood disorders such as anxiety and post-traumatic stress disorder (PTSD).

Desyrel and Oleptro are two brand names for trazodone.

Is Trazodone Addictive?

According to the DEA, trazodone doesn't have any risk for drug abuse or addiction.

With regular use, some people develop a mild physical dependence. This dependence becomes apparent when they stop taking the drug.

What is Trazodone Used For?

Trazodone is an ‘atypical antidepressant’. It affects the brain differently than more common antidepressants.

It's part of a class of drugs called serotonin-antagonist-and-reuptake-inhibitor (SARIs). These are often confused with selective serotonin reuptake inhibitors (SSRIs).

SARIs like trazodone inhibit the reuptake of serotonin and antagonize the action of histamine and alpha-1-adrenergic receptors, which are responsible for stimulation.

Trazodone reduces activity in parts of the brain that cause depression and anxiety, just like the serotonin reuptake inhibitors and tricyclic antidepressants.

Trazodone - Risks, Side Effects, Addiction

Trazodone manages symptoms linked to:

  • Depression
  • Anxiety disorders

Its calming effects can also treat people with:

  • Insomnia
  • Eating disorders
  • Substance use disorders
  • Post-traumatic stress disorder (PTSD)
  • Some pain conditions like fibromyalgia

Trazodone is the most commonly prescribed (off-label) aid to treat sleep disorders like insomnia. It isn't FDA-approved to treat sleep disorders.

One study found that trazodone is comparable in its anti-anxiety effects to diazepam.2 This drug is sold under the brand name Valium.

Researchers are assessing whether the drug can help people with neurodegenerative disorders like:

  • Muscular sclerosis (MS)
  • Alzheimer’s Disease
  • Parkinson’s Disease

A 2019 pilot study in people with Alzheimer’s Disease found that trazodone reduced symptoms of dementia. It also slowed cognitive decline.3

Types of Trazodone Pills

Trazodone pills come in various forms. It's prescribed based on the strength and duration of the depression along with other factors.

The pills and dosages available are:

  • Desyrel 50 mg/PLIVA 433
  • Desyrel 100 mg/PLIVA 434
  • Desyrel 150 mg/IT150
  • Desyrel 300 mg/bar 733

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Risks of Trazodone

Trazodone isn't linked to a risk for abuse or addiction. But there are still some risks associated with its use. Among these are:

Suicidal Thoughts

The most severe risk of trazodone use is the risk of suicidal thoughts or actions. This risk is especially concerning among teenagers and young adults.

The risk for suicide is generally higher in those with untreated depression. However, it's essential to be aware of signs of suicidal ideation, especially in the first few months of taking it.

Suicidal thoughts or actions are the most dangerous risk associated with taking trazodone. Young adults are most likely to be affected.

U.S. Food and Drug Administration

Serotonin Syndrome

Serotonin syndrome is a potentially life-threatening condition. It's caused by excess serotonin levels in the brain.

Taking too much trazodone or mixing it with other drugs that reduce serotonin reuptake increases the risk of serotonin syndrome.

Symptoms of serotonin syndrome include:

  • Tremor
  • Stiff muscles
  • Excessive sweating
  • Vomiting
  • Diarrhea
  • Irritation

In extreme cases, hallucinations and seizures may occur. Serotonin syndrome can be fatal and requires immediate medical treatment.

The use of other serotonergic drugs, such as triptans, tricyclic anttidepressants, or fentanyl, can also dangerously increase serotonin levels.

Many people take the OTC herbal drug St. John’s Wort. This substance eases depression symptoms by modestly increasing serotonin levels. People who take trazodone or another antidepressant should never take St. John's Wort.

Antidepressant Discontinuation Syndrome

Some people who quit taking trazodone abruptly will experience antidepressant discontinuation syndrome.

Symptoms of this include:

  • Sensory disturbances (vertigo, lightheadedness)
  • Altered sleep patterns
  • Headache
  • Anxiety
  • Dizziness

Trazodone Overdose

Trazodone overdoses aren't common, but they're possible.

The risk for overdose increases if trazodone mixes with other substances, especially other CNS depressants. Caution should also be practiced in those who have severe liver and renal impairment.

Symptoms of trazodone overdose include:

  • Chest pain
  • Irregular heartbeat
  • Decreased heart rate
  • Low blood pressure
  • Difficulty breathing or respiratory arrest
  • Dizziness and lack of coordination
  • Drowsiness
  • Headache
  • Nausea
  • Vomiting
  • Seizures
  • Tremors
  • Coma

Trazodone overdose can also lead to more severe side effects.

These include:

  • Serotonin syndrome, presenting as a triad of mental status change, movement changes and changes in vital signs
  • Priapism: a painful erection that lasts for more than 4 hours)
  • Cardiac conduction abnormalities: potentially deadly disorders of the electrical system controlling your heart rate and rhythm
  • Severe hypotension: low blood pressure

Side Effects of Trazodone

Trazodone works by interrupting serotonin signaling. This has several physiological consequences.

Serotonin is widely understood to be the ‘depression’ neurotransmitter.

It also has important roles in other regulatory systems in the body, including:

  • Maintaining body temperature
  • Regulating the gastrointestinal system
  • Maintaining cardiovascular function
  • Functioning of the genitourinary system

Thus, trazodone use is often linked with side effects unrelated to mood.

Common side effects of trazodone use include:

  • Sedation
  • Drowsiness
  • Dry mouth
  • Headache
  • Nausea/vomiting
  • Diarrhea
  • Low blood pressure (hypotension)
  • Dizziness
  • Muscle aches
  • Blurred vision
  • Constipation

Trazadone may also cause more serious side effects.

Severe side effects include:

  • Chest pain
  • Shortness of breath
  • Difficulty breathing
  • Sexual dysfunction
  • Fast or irregular heart rate or rhythm

Trazodone Interactions

Before taking a new drug, speak with your pharmacist about any possible interactions. You should share your medical history and any other medications you're currently or recently stopped taking.

Tell your doctor if you or your family has any history of:

  • Bipolar disorder
  • Liver disease
  • Heart disease
  • Heart attacks
  • Suicide attempts

Additionally, trazodone interacts with hundreds of other drugs.

Common interactions include, but aren't limited to:

  • MAO Inhibitors
  • Antifungals
  • HIV protease inhibitors
  • Macrolide antibiotics
  • Seizure medications
  • Rifamycins
  • Drugs that increase serotonin, like St. John's wort and MDMA/ecstasy
  • Drugs that cause drowsiness, such as alcohol and marijuana

This isn't a complete list of trazodone interactions. Share all current, recent, and future medications with your doctor to avoid adverse reactions.

This includes any:

  • Prescription medications
  • OTC drugs
  • Herbal supplements

Trazodone Abuse & Addiction Symptoms

Since there's little to no risk for trazodone addiction, there are no addiction symptoms.

Addiction involves having obsessive drug-seeking behavior despite health or social consequences. Even long-term trazodone use doesn't lead to addictive behavior.

There's a risk of developing a mild physical dependence on trazodone. Although uncommon, some people who stop taking the drug experience symptoms linked to antidepressant discontinuation syndrome.

Addiction Treatment

Trazodone isn't addictive. But around 20 percent of people who stop taking antidepressants experience antidepressant discontinuation syndrome.6 This is similar to acute withdrawal symptoms.

This syndrome isn't well understood, and it doesn't affect everyone who quits taking antidepressants.

For those affected, symptoms can be very uncomfortable and disorienting. People who have taken trazodone for a long time are more likely to experience discontinuation syndrome.

Symptoms of antidepressant discontinuation syndrome include:

  • Nausea
  • Insomnia
  • Disorientation
  • Sensory disturbances
  • Hyperarousal

These symptoms typically last for a few days. In rare cases, people may experience symptoms for two to three weeks.

Around 20 percent of people who stop taking trazodone will experience symptoms of antidepressant discontinuation syndrome. For example, lightheadedness and insomnia.

The best way to prevent or reduce discontinuation syndrome symptoms is to work with a doctor. Together you can develop a dosing schedule, in which you taper off the drug.

Tapering means gradually reducing the dose over several days or weeks. By doing this, the brain becomes used to working without trazodone.

Aside from this, there are also a variety of possible treatment options, including:

Substance abuse is a medical emergency and requires immediate professional care. Those suffering from addiction should consult their doctor for options.

Summary

Trazodone is a commonly prescribed antidepressant that's generally well-tolerated and isn't addictive.

However, people detoxing from the drug may experience uncomfortable symptoms. These symptoms are the result of antidepressant discontinuation syndrome.

Depression isn't the only condition that trazodone improves. Doctors often prescribe it to help people sleep better, manage stress and anxiety, and reduce pain.

Clinical trials are being conducted to determine whether trazodone can help people with neuropathic pain and sleep apnea. The trials also assess whether the drug can improve memory in people with depression.

If you want to stop taking trazodone or another antidepressant, help is available. Speak to a medical professional at a treatment center today.

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Resources

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  1. Shin, Justin J and Saadabadi, Abdolreza. “Trazodone.” StatPearls. Treasure Island (FL): StatPearls Publishing; 2019
  2. Rickels, Karl et al. “Antidepressants for the Treatment of Generalized Anxiety Disorder: A Placebo-Controlled Comparison of Imipramine, Trazodone, and Diazepam.” Archives of general psychiatry vol. 50,11 : 884-895
  3. Ashford, John Wesson. “Treatment of Alzheimer's Disease: Trazodone, Sleep, Serotonin, Norepinephrine, and Future Directions.” Journal of Alzheimer's disease : JAD vol. 67,3 : 923-930
  4. U.S. Food and Drug Administration. “Highlights of prescribing information: Desyrel (trazodone hydrochloride).” Revised June 2017
  5. Francescangeli, James et al. “The Serotonin Syndrome: From Molecular Mechanisms to Clinical Practice.” International journal of molecular sciences vol. 20,9 2288. 9 May. 2019
  6. Warner, Christopher E, et al. “Antidepressant discontinuation syndrome.” American family physician. vol. 74,3 :449-456. PMID: 16913164
  7. ClinicalTrials.gov. National Library of Medicine (U.S.). (2000, February 29 – ). “Trazodone/Gabapentin Fixed Dose Combination Products in Painful Diabetic Neuropathy.” Identifier NCT03749642. Retrieved February 5, 2020
  8. ClinicalTrials.gov. National Library of Medicine (U.S.). (2000, February 29 – ). “Treatment of Sleep Apnea in Patients With Cervical Spinal Cord Injury.” Identifier NCT02922894. Retrieved February 5, 2020
  9. ClinicalTrials.gov. National Library of Medicine (U.S.). (2000, February 29 – ). “Memory Enhancement by Gamma-hydroxybutyrate vs. Trazodone in Major Depressive Disorder.” Identifier NCT04082806. Retrieved February 5, 2020

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