Trazodone (טראזודון) – We are all too familiar with an overactive mind when it’s time to sleep. It’s a common problem with mental health and sleep too. An anxious mind will hinder sleep and the lack of sleep will impairment an anxious mind.
For decades, Trazodone (known in Israel and other regions as טראזודון) has been used to treat this problem. It was first approved by the FDA as an antidepressant, but because of its sedating effects, it has become widely prescribed for the treatment of insomnia as well.
How can a single pill elevate your mood, and also put you to sleep? Before you start taking Trazodone, you should learn about its advantages, safety, and mechanism.
Understanding Trazodone
To see Trazodone’s effects, it helps to look at brain chemistry. More specifically, a certain class of drugs called Serotonin Antagonist and Reuptake Inhibitors (SARIs). Trazodone classifies as a SARI, but is often marketed as a serotonin modulator.
Serotonin and Its Regulation
Trazodone, like other antidepressants, impacts serotonin, a neurotransmitter involved in the regulation of mood, sleep, and appetite. It helps the brain retain serotonin by preventing its reabsorption, thereby increasing its availability for the neuron to use. This is essential for the treatment of Major Depressive Disorder (MDD).
Sedative Properties
Trazodone’s sedative effects are what differentiate it from other standard SSRIs like Prozac or Zoloft. Trazodone inhibits certain receptors in the brain, particularly the H1 and Alpha 1 adrenergic receptors.
Because of the blockade of H1 receptors, there is a significant sedative effect, which is quite similar to the sedation effect caused by some older antihistamines. As a result, Trazodone is able to promote sleep quite effectively, which is the reason many doctors prescribe the medication for patients that have trouble falling asleep.
Trazodone’s Unique, Dual-Function
Trazodone is prescribed for a variety of comorbid conditions and the prescribed dosage depends on the patient’s individual needs. Considered a dual-use medicine, it offers flexibility to the physician.
Treatment of Major Depressive Disorder
Trazodone is FDA-approved for the treatment of Major Depressive Disorder (MDD) in adults. This means that for patients suffering from depression, particularly MDD, that is comorbid with significant anxiety or insomnia, Trazodone offers a two-birds-with-one-stone solution.
In contrast to certain newly released antidepressants which might produce side effects like jitteriness or insomnia, Trazodone may facilitate mood stabilization while not overstimulating the nervous system due to its calming nature.
Use for insomnia
Trazodone is not FDA-approved for insomnia, but it is frequently prescribed for it “off-label”. Doctors may prefer it to other sleep medications (like benzodiazepines or “Z-drugs”) because it is typically deemed non-addictive, and not subject to dependency or abuse.
However, there is a division among the medical community about its effectiveness for long-term sleep problems. The American Academy of Sleep Medicine (AASM) has, in 2017, published guidelines recommending that physicians refrain from prescribing Trazodone for long-term chronic insomnia because of the absence of quality data that support its long-term efficacy. Nevertheless, it is frequently used in a clinical setting for short-term insomnia or sleep problems associated with mood disorders.
Finding the right dose
The differentiation between using Trazodone for depression and sleep is typically due to the dose. The medication has a large range of dosing, and the effects vary widely with increasing amounts.
Dosage for sleep
Trazodone is prescribed for sleep in low doses.
- Typical range: 25 mg to 100 mg.
- Goal: At this dose, the medication targets the histamine receptors to induce sedation, though it may be insufficient to elicit a complete antidepressant response.
- Timing: It is typically taken about 30 minutes prior to sleep.
Dosage for depression
To adequately adjust serotonin levels, the treatment of clinical depression typically necessitates higher doses.
- Typical range: 150 mg to 400 mg daily.
- Administration: Increased doses are usually taken in divided doses throughout the day, or in a single dose at night, to reduce the likelihood of daytime sedation.
- Titration: To reduce the likelihood of adverse effects, physicians typically initiate treatment at a lower dose and slowly increase it.
Note: It is recommended that Trazodone be taken after a light snack or meal. The likelihood of experiencing dizziness or nausea is heightened when Trazodone is taken on an empty stomach.
Side effects and risks
Trazodone, like any substantial psychiatric medication, carries an array of possible side effects, although it is usually seen as safe. Many side effects can be managed, however, certain effects may arise that necessitate urgent medical care.
Common side effects
Most complaints are due to the sedative effects of the medication:
- Drowsiness: The “hangover effect” is real. Many users feel a degree of morning grogginess, particularly when they are new to the medication.
- Dizziness and lightheadedness: When someone is standing, and their blood pressure drops, it may cause dizziness and lightheadedness due to orthostatic hypotension.
- Dry mouth: A common experience with many types of antidepressants.
- Blurred vision: This may occur and usually it is temporary and should be monitored.
Serious warnings
With Trazodone, there are rare but serious risks to be aware of.
Priapism
Trazodone is known for priapism as a side effect, which is a medical condition where someone has an erection that lasts for over 6 hours. This is a medical emergency, and if it is not treated right away, it can be cause permanent damage to the tissues. While it is very rare, it is a risk with this medication.
Serotonin syndrome
Trazodone, when taken with other serotonergic medications (such as other antidepressants, migraine medications that are classified as triptans, and certain types of supplements), can cause serotonin syndrome. This is when too much serotonin accumulates in the body. Symptoms may include, but are not limited to, agitation, hallucinations, rapid and increased heart rate, fever, and stiff muscles.
Suicidality
All antidepressants, including Trazodone, have a boxed warning that there is an increased risk for suicidal thoughts and behaviors in younger adults, adolescents, and children. Families and caregivers should closely monitor patients for any sudden changes in mood or behavior.
Is Trazodone the right medication for you?
Trazodone is an important medication for difficult cases when sleep problems and mood problems occur together. It is an antidepressant, so it helps with major depressive disorder, and it serves as an effective, non-addictive option (i.e. non-benzodiazepine ) to aid with sleep/rest issues.
Nonetheless, Trazodone is not a perfect option for everyone. It has very significant sedation and sleepiness effects for some and may interact with some other medications. Talk with your physician if you have sleep problems and/or depression for a full evaluation to see if Trazodone is an appropriate option to consider.
