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Updated on July 20, 2021

Trazodone - Risks, Side Effects, Addiction, and Treatment

What is Trazodone?

Trazodone is a generic antidepressant prescription medication that is used to treat major depressive disorder and other mood disorders, including anxiety and post-traumatic stress disorder (PTSD).

Desyrel and Oleptro are two brand names for trazodone.

Is Trazodone Addictive?

According to the U.S. Drug Enforcement Administration (DEA), trazodone does not have any risk for drug abuse or drug addiction. However, with regular use some people develop a mild physical dependence that becomes apparent when they stop taking the drug.

What is Trazodone Used For?

Trazodone - Risks, Side Effects, Addiction

Trazodone is an ‘atypical antidepressant’ that affects the brain differently than more common antidepressants. Trazodone belongs to a class of drugs called selective serotonin re-uptake inhibitors (SSRIs), which are antidepressant medications block serotonin signaling in specific receptors in the brain. The overall effect of trazodone is to reduce activity in parts of the brain that cause depression and anxiety.

Trazodone manages symptoms associated with:

  • Depression
  • Anxiety disorders

It's sedative effects have also proven to be helpful in treating people with:

  • Insomnia
  • Eating disorders
  • Substance use disorders
  • Some pain conditions

In fact, trazodone is the most commonly prescribed (off-label) sleep aid to treat insomnia and trouble sleeping, although it is not FDA-approved to treat sleep disorders. Additionally, one study found that trazodone is a more effective anti-anxiety medication than the popular (and powerfully addictive) prescription drug diazepam, which is sold under the brand name Valium.

Medical researchers are currently evaluating whether trazodone can help people with neurodegenerative disorders like muscular sclerosis (MS), Alzheimer’s Disease, and Parkinson’s Disease. A 2019 pilot study in humans with Alzheimer’s Disease found that trazodone reduced symptoms of dementia and slowed cognitive decline.

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Risks of Trazodone

Trazodone is not associated with a risk for abuse or addiction, but there are some risks that people should be aware of before they take the drug.

Suicidal Thoughts

The most serious risk associated with trazodone use is an increased risk for suicidal thoughts or actions, particularly among teenagers and young adults (24 years and younger). The risk for suicide is lower among people taking trazodone it is for people with untreated depression, but it is important 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, and young adults are the most likely to be affected.

U.S. Food and Drug Administration

Serotonin Syndrome

Serotonin syndrome is a potentially life-threatening condition that is caused by excess serotonin levels in the brain. Taking too much trazodone or combining it with other drugs that inhibit serotonin reuptake increases the risk that someone will experience serotonin syndrome.

Many people take the over-the-counter herbal drug St. John’s Wort, which eases depression symptoms by modestly increasing serotonin levels. People who take trazodone or another antidepressant should never take St. John's Wort. If you are given a prescription for an antidepressant, make sure to tell your doctor about any other prescription, over-the-counter, or illegal drugs that you use.

Antidepressant Discontinuation Syndrome

About 20 percent of people who quit taking trazodone abruptly will experience antidepressant discontinuation syndrome, which is a group of symptoms that often include sensory disturbances (vertigo, lightheadedness), altered sleep patterns, headache, anxiety, and dizziness.

Side Effects of Trazodone

Trazodone works by interrupting serotonin signaling, which has several physiological consequences. Serotonin is widely understood to be the ‘depression’ neurotransmitter, but it has important roles in other regulatory systems in the body, including maintaining body temperature, regulationing the gastrointestinal system, and maintaining cardiovascular function. Thus, trazodone use is often associated with several side effects that are 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, and fast or irregular heart rate or heart rhythm.

Trazodone Overdose

Trazodone overdoses are not common, but it is possible. The risk for overdose is multiplied if trazodone is mixed with other substances, especially other CNS depressants.

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 serious side effects. These include:

  • Serotonin syndrome
  • Priapism (a painful erection that lasts for more than 4 hours)
  • Cardiac conduction abnormalities (potentially deadly disorders of the electrical system that controls your heart rate and rhytm)
  • Severe hypotension (low blood pressure)

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Trazodone Interactions

Anytime you take a new drug, speak with your pharmacist about any possible interactions. You should disclose all of your medical history and any other medications you are currently or recently stopped taking. Specifically, tell your doctor if you or your family has any history of:

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

In addition to these health conditions, trazodone interacts with hundreds of other drugs. Common interactions include, but are not limited to:

  • MAO Inhibitors including methylene blue, isocarboxazid, selegiline, linezolid, moclobemide, tranylcypromine, procarbazine, rasagiline, safinamide, phenelzine, etc.
  • Antifungals such as itrazonazole and ketoconazole
  • HIV protease inhibitors like ritonavir and indinavir
  • Macrolide antibiotics such as erythromycin
  • Seizure medications including phenytoin
  • Rifamycins such as rifampin
  • Drugs that increase serotonin like St. John's wort, MDMA/ecstasy, certain antidepressants including SSRIs and SNRIs
  • Drugs that cause drowsiness such as alcohol, marijuana, antihistamines, sleeping pills, anxiety medication, muscle relaxants, and opioid pain relievers

This is not a complete list of trazodone interactions. Speak with your doctor and share all current, recent, and future medications with them (including prescription, over-the-counter, and herbal supplements) to avoid adverse reactions.

Trazodone Abuse & Addiction Symptoms

Since there is little to no risk for trazodone addiction, there are no addiction symptoms. The definition of addiction is having obsessive drug-seeking behavior in the face of adverse health and/or social consequences, and even long-term trazodone use does not lead to addictive behavior.

There is a risk for developing a mild physical dependence on trazodone. Although it’s not common, some people who suddenly stop taking the drug will experience uncomfortable symptoms associated with antidepressant discontinuation syndrome.

Addiction Treatment

Trazodone is not addictive, but around 20 percent of people who stop taking the drug will experience antidepressant discontinuation syndrome, which is similar to acute withdrawal symptoms.

This syndrome is not well understood, and it does not affect everyone who quits taking antidepressants. For the people who are affected, symptoms can be very uncomfortable and disorienting. People who have taken trazodone for a long time are more likely to experience discontinuation syndrome.

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

American Family Physician

The best way to prevent or minimize symptoms of discontinuation syndrome is to work with a doctor to develop a dosing schedule that progressively declines over time. By gradually reducing the dose over a period of several days or weeks, the brain becomes accustomed to functioning without trazodone.

Symptoms of antidepressant discontinuation syndrome typically last for a few days, but in rare cases people may experience prolonged symptoms that persist for two to three weeks.

One trazodone-related event that requires medical treatment is serotonin syndrome. Serotonin syndrome is caused by too much serotonin in the brain.

Symptoms of serotonin syndrome include:

  • Tremor
  • Muscle rigidity
  • Excessive sweating
  • Vomiting
  • Diarrhea
  • Agitation

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

Summary

Trazodone is a commonly prescribed atypical antidepressant that is generally well-tolerated and is not addictive. However, people who quit taking trazodone abruptly or detox, may experience uncomfortable symptoms as a result of antidepressant discontinuation syndrome.

Depression is not 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 currently being conducted to determine whether prescribing trazodone can help people with neuropathic pain and sleep apnea, and enhance memory in people with depression.

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

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Resources

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Shin, Justin J and Saadabadi, Abdolreza. “Trazodone.” StatPearls. Treasure Island (FL): StatPearls Publishing; 2019, https://www.ncbi.nlm.nih.gov/books/NBK470560/

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 (1993): 884-895. doi:10.1001/archpsyc.1993.01820230054005, https://jamanetwork.com/journals/jamapsychiatry/article-abstract/496392

Ashford, John Wesson. “Treatment of Alzheimer's Disease: Trazodone, Sleep, Serotonin, Norepinephrine, and Future Directions.” Journal of Alzheimer's disease : JAD vol. 67,3 (2019): 923-930. doi:10.3233/JAD-181106, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398534/

U.S. Food and Drug Administration. “Highlights of prescribing information: Desyrel (trazodone hydrochloride).” Revised June 2017, https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018207s032lbl.pdf

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, doi:10.3390/ijms20092288, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6539562/

Warner, Christopher E, et al. “Antidepressant discontinuation syndrome.” American family physician. vol. 74,3 (2006):449-456. PMID: 16913164, https://www.aafp.org/afp/2006/0801/p449.html

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, https://clinicaltrials.gov/ct2/show/NCT03749642?term=NCT03749642&draw=2&rank=1

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, https://clinicaltrials.gov/ct2/show/NCT02922894?term=NCT02922894&draw=2&rank=1

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, https://clinicaltrials.gov/ct2/show/NCT04082806?term=NCT04082806&draw=2&rank=1

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