Trazodone: what it is used for, trazodone for sleep and side effects

Trazodone is an antidepressant that acts on serotonin, a chemical messenger in the brain. It comes as tablets, is sold as a generic and needs a prescription.

Trazodone is not a controlled substance: its FDA-approved label says so. It is still a medicine with real side effects and important warnings, and it should be used under medical supervision.

According to its FDA label, trazodone is indicated for the treatment of major depressive disorder in adults. That is its only approved use. It is not approved for children.

According to MedlinePlus, doctors sometimes use it for other things that are not on the label (off-label use), such as insomnia and anxiety. Off-label is not forbidden, but it means the FDA did not evaluate the medicine for that purpose.

For depression, trazodone does not work overnight: according to MedlinePlus, it can take 2 weeks or longer to feel the full benefit. For the condition itself, read depression. Another widely used antidepressant is bupropion (Wellbutrin).

Trazodone makes you sleepy. In the studies on its label, 41% of outpatients taking it had drowsiness, compared with 20% on placebo. That is why it is prescribed so often for sleep, even though that use is not FDA-approved.

The 2017 American Academy of Sleep Medicine (AASM) guideline on medicines for chronic insomnia in adults suggests not using trazodone for falling asleep or staying asleep. It is a weak recommendation, because the evidence is limited, but it is a recommendation against.

The same guideline says everyone with chronic insomnia should receive cognitive behavioral therapy for insomnia (CBT-I) first, and that medicines are mainly for people who cannot do that therapy or still have symptoms despite it. If your problem is that you cannot sleep, read our page on insomnia.

That does not mean trazodone is never used for sleep. The doctor may consider it in specific cases, for example when depression comes with the sleep problem. She decides after evaluating you, reviewing your other medicines and explaining the risks. Another antidepressant that causes drowsiness, sometimes considered when depression comes with insomnia, is mirtazapine (Remeron).

The FDA label gives a dose only for depression: it suggests starting at 150 mg a day in divided doses, increasing gradually if needed and, for outpatients, generally not going above 400 mg a day. The label says to take it shortly after a meal or light snack.

The lower doses some people take for sleep, such as 50 mg, are not on the label, because sleep is not part of it. This page does not recommend any dose. Any dose is set by the doctor after evaluating you and reviewing your other medicines. Do not change your dose on your own.

According to the FDA label and MedlinePlus, the most common side effects of trazodone are:

Suicidal thoughts in young people. Trazodone carries the boxed warning shared by all antidepressants: in children, teens and young adults (up to age 24) they can increase suicidal thoughts and behaviors, especially in the first months and when the dose changes. You and your family should watch for changes in mood or behavior.

Priapism. Trazodone can cause an erection that will not go down. According to the label, if an erection lasts more than 4 hours, painful or not, stop the medicine and go to the emergency room. Without prompt treatment it can cause permanent damage to the penis.

Low blood pressure, dizziness and falls. It can drop your blood pressure when you stand and cause fainting. The label asks for caution in older adults, who are at higher risk of falling. Get up slowly from bed or a chair.

Heart rhythm. Trazodone can prolong the QT interval on the electrocardiogram. It is avoided in people with known QT prolongation and used with caution if you have heart disease or take other QT-prolonging medicines.

Serotonin syndrome. Combined with other medicines that raise serotonin (other antidepressants, triptans for migraine, tramadol, St. John's wort or tryptophan), it can cause fever, stiffness, tremor, agitation and confusion. It is an emergency.

Other label risks: more bleeding if taken with aspirin, anti-inflammatories or blood thinners; low blood sodium; angle-closure glaucoma; and manic episodes in people with bipolar disorder. It is not taken with MAO inhibitors or within 14 days of stopping one.

Driving. It can affect your ability to drive or operate machinery. Do not drive until you know how it affects you.

The FDA label warns that trazodone may enhance the effect of alcohol, barbiturates and other central nervous system depressants, such as medicines for sleep, anxiety or pain (opioids). The combination can mean more drowsiness, more dizziness and a higher risk of falling. MedlinePlus says alcohol can make the side effects worse. Ask the doctor before drinking alcohol or combining it with another medicine.

Do not stop taking trazodone without talking to your doctor. According to the label and MedlinePlus, stopping suddenly can cause nausea, sweating, dizziness, headache, anxiety, low mood and trouble sleeping. The usual approach is to lower the dose gradually, as your doctor directs.

If you are thinking about hurting yourself or ending your life, do not wait for an appointment. Call the Línea PAS at 1-800-981-0023, free and at any hour, or call or text 988. If you are in danger right now, call 911.

If you take trazodone and have any of these signs, call 911 or go to the emergency room. See when to go to the ER.