Trazodone, originally developed in Italy during the 1960s as an antidepressant, has since found additional applications due to its sedative properties. Initially, the drug was met with some resistance because of side effects like dizziness, fainting, irregular heartbeat, and, in rare cases, priapism in men. However, over time, it became clear that at lower doses, trazodone could be beneficial for treating sleep disorders, anxiety, and unipolar depression. The U.S. Food and Drug Administration (FDA) approved trazodone under the brand name Desyrel in 1981 for major depressive disorder. Today, it is also prescribed under the brand name Oleptro for sleep disorders and anxiety.
Does Trazodone Cause Sleepiness?
For many users, trazodone induces a sedative effect, creating a relaxed, sleepy feeling. Physicians typically prescribe low doses at bedtime to mitigate drowsiness the next day. However, some individuals report lingering effects such as sluggishness and a lack of energy, particularly upon waking.
How Does Trazodone Alleviate Depression?
Trazodone works by increasing neurotransmitters in the central nervous system, particularly serotonin, which plays a critical role in regulating sleep, mood, appetite, digestion, memory, and sexual function. Many experts believe that depression results from an imbalance of neurotransmitters, including acetylcholine, norepinephrine, dopamine, and serotonin. Trazodone inhibits serotonin uptake by nerves and stimulates other nerves, helping restore balance and alleviate depressive symptoms.
How Quickly Does Trazodone Take Effect?
When used for sleep disorders, trazodone’s sedative effects can begin within 30 minutes. For depression, it may take one to two weeks for initial symptom relief, and up to four weeks for the full benefits to manifest.
Is Trazodone Safe for Treating Depression?
Like all medications, trazodone can cause side effects. It is important to discuss potential side effects, drug interactions, and withdrawal symptoms with a physician.
Do All Antidepressant Drugs Work the Same Way?
Antidepressants are designed to affect brain chemistry, but they work through different mechanisms. The most common antidepressants are reuptake inhibitors, which prevent the reabsorption of neurotransmitters like serotonin and norepinephrine, thereby strengthening mood-regulating circuits in the brain. These include:
- Selective Serotonin Reuptake Inhibitors (SSRIs): Prozac, Zoloft, Paxil, Lexapro, Celexa, Luvox.
- Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs): Cymbalta, Effexor.
- Norepinephrine and Dopamine Reuptake Inhibitors (NDRIs): Wellbutrin.
Trazodone, classified as an “atypical antidepressant,” does not fit into these categories, making it unique in its approach.
Is Trazodone Safe for Insomnia?
Although originally designed for depression and anxiety, trazodone is now commonly prescribed as a sleep aid for acute insomnia due to its sedative properties.
How is Trazodone Different from Other Sleeping Pills?
Trazodone differs from medications like Ambien, Sonata, and Lunesta in several ways:
- Controlled Substance Status: Ambien and Lunesta are controlled substances with a potential for misuse and dependence. Trazodone is not classified as a controlled substance.
- Prescription Limits: Physicians face fewer restrictions when prescribing trazodone compared to controlled substances.
- Cost and Insurance: Trazodone is an inexpensive generic drug typically covered by insurance.
- Addiction Potential: Trazodone is not considered addictive when used as prescribed.
Pregnant women or those breastfeeding should avoid trazodone.
Risks Associated with Trazodone for Depression
For patients under age 24, trazodone carries heightened mental health risks. Side effects can include worsening depression, suicidal thoughts, extreme worry, agitation, panic attacks, sleep disturbances, aggressive behavior, irritability, impulsive actions, severe restlessness, and frenzied excitement. Immediate consultation with a physician is crucial if these symptoms occur.
Drug Interactions with Trazodone
Patients must avoid self-medicating with over-the-counter drugs, supplements, or alcohol while on trazodone, as these can lead to serious interactions, including serotonin syndrome, which can be fatal. Symptoms of serotonin syndrome include tremors, muscle aches, sweating, anxiety, confusion, tachycardia, delirium, hallucinations, seizures, renal failure, and death.
Trazodone Side Effects
Common side effects of trazodone include:
- Drowsiness
- Dizziness
- Dry mouth
- Constipation
- Headache
- Fatigue
- Tingling or numbness
- Blurred vision
- Disorientation
- Vertigo
- Nasal congestion
- Shaking
- Anxiety
- Muscle aches
- Priapism (prolonged, painful erections)
- Low blood pressure
- Heart rhythm disorders
- Increased risk of suicidal thoughts and behaviors in children and adolescents
Addiction and Withdrawal
While trazodone is not considered addictive, it should be taken only as prescribed to avoid misuse, especially for individuals with a history of substance abuse. Misuse signs include using without a prescription, exceeding prescribed doses, or altering the drug form (e.g., crushing or snorting).
Trazodone can cause withdrawal symptoms if discontinued abruptly. Tapering off the medication under medical supervision is recommended to avoid symptoms such as agitation, confusion, mood swings, muscle pain, weakness, dizziness, stomach pain, sweating, insomnia, and fatigue.
Trazodone is a versatile medication that serves both as an antidepressant and a sleep aid. While it offers significant benefits, it also comes with potential risks and side effects. Understanding these aspects is crucial for safe and effective use, particularly for those managing addiction and mental health challenges. Always consult a healthcare professional before starting or adjusting trazodone treatment. For families and friends in South Africa supporting a loved one through recovery, being informed about medications like trazodone can be a valuable part of the journey towards health and wellness.
