Is it Safe and Effective?

Trazodone is often prescribed for sleep problems. However, it’s FDA-approved to treat depression and anxiety. Because it can make you sleepy, healthcare providers prescribe it off-label (given legally but for a use unapproved by the FDA) to treat sleep disorders such as insomnia.

Trazodone does not cause dependence or addiction but it can cause side effects. It also interacts with many medications.

Uses

Trazodone (Desyrel and Desyrel Dividose) is a prescription medication that has been used to treat depression for many years. Though it’s not a sleep medicine, it has a sedative effect that causes drowsiness. For this reason, it’s often prescribed off-label to treat insomnia.

Insomnia makes it difficult to fall and stay asleep. You may also wake up too early and not get back to sleep. Many people occasionally have insomnia. But for some, it turns into a chronic sleep condition that doesn’t improve without treatment.

How It Works

Trazodone acts on two neurotransmitters, serotonin and histamine, which are chemical messengers in the brain.

Serotonin

Trazodone helps serotonin build up in the spaces between nerve cells by blocking it from entering nearby cells. This increases serotonin in your brain.

Serotonin regulates mood, sleep, hunger, and body temperature. Low serotonin levels cause depression, anxiety, bipolar disorder, and many mental health conditions. Having low serotonin also affects your sleep.

Histamine

Trazodone affects histamine, another brain neurotransmitter that keeps you awake and alert. Taking Trazodone may make you sleepy by blocking histamines. This is similar to the effect of another common antihistamine, Benadryl (diphenhydramine).

Effectiveness

A 2017 review reported that trazodone helps people fall asleep faster and sleep longer. Another review published in 2023 found that trazodone significantly decreased nightly awakenings and slightly improved sleep quality.

However, the American Academy of Sleep Medicine does not recommend trazodone to treat insomnia based on its overall effectiveness.

Research suggests it only reduces the time it takes to fall asleep by about 10 minutes. In addition, the amount of time spent awake at night is only reduced by eight minutes on average.

The American Academy of Sleep Medicine also found that trazodone doesn’t significantly improve the ratio between the amount of time spent in bed and the amount of time spent sleeping, nor does it significantly improve waking time after falling asleep.

Despite the limited clinical evidence, many healthcare providers prescribe trazodone as a first-line treatment for insomnia. A 2023 study concluded that healthcare providers who recommend trazodone may not be fully aware of the weak clinical evidence.

Recommended Treatment for Insomnia

Sleep medications, including trazodone, are not the preferred treatment for insomnia. Healthcare experts (including the American Academy of Sleep Medicine) recommend treating insomnia with cognitive behavioral therapy for insomnia (CBT-I).

CBT-I is more effective compared to medications. Therapy also doesn’t have the serious side effects of sleep medications.

Benefits

If CBT-I doesn’t improve your sleep, your healthcare provider may recommend Trazodone. In addition to making you drowsy, it may have other potential benefits: 

No Addiction Risk

Trazodone is not a controlled substance (like some sleep medications) because it does not cause dependence or addiction.

May Slow Memory Loss

Research published in the Journal of Alzheimer’s Disease reports that Trazodone may delay cognitive decline and memory loss in dementia by improving slow-wave sleep.

Researchers have also discovered that low serotonin levels may contribute to memory loss in the early stage of Alzheimer’s disease. Though there’s no evidence that Trazodone may slow Alzheimer’s, future studies may find that its ability to increase serotonin can help.

May Improve Sleep Apnea

A 100 milligram (mg) dose of Trazodone may reduce the number of times people with sleep apnea stop breathing. How often a person temporarily stops breathing determines the severity of their sleep apnea.

Side Effects

You may or may not experience side effects with trazodone. Some of them are common; others are rare but can be severe.

If you develop side effects, don’t stop taking the medication abruptly. Your healthcare provider will reduce the dose gradually to prevent side effects.

Common

When reported, some of the most common side effects include:

• Dizziness
• Lightheadedness
• Dry mouth
• Headache
• Blurred vision
• Nausea or vomiting
• Nervousness
• Fatigue
• Constipation
• Low blood pressure
• Skin reactions, such as a rash
• Confusion
• Muscle pain
• Diarrhea
• Tremor (shakiness)
• Difficulties with walking or coordination

Severe

With the use of any drug, there are also risks of serious side effects. When using trazodone, these may include:

• Suicidal thoughts and behaviors
• Serotonin syndrome
• Abnormal heart rhythms (arrhythmia)
• Orthostatic hypotension (low blood pressure when moving from sitting to standing)
• Increased risk of bleeding
• Painful erections (priapism)
• Low sodium (hyponatremia)
• Mania (high energy, hyperactivity, racing thoughts)
• Impaired thinking and judgment
• Angle-closure glaucoma (narrow-angle glaucoma)

Who Should Not Use Trazodone

People currently taking antidepressants called MAOIs should not start trazodone until they have been off the MAOI for at least 14 days.

There are certain instances where you may want to avoid using trazodone for insomnia. It’s important that you talk to your healthcare provider about the risks of trazodone if you are:

• At risk for suicide
• Pregnant or breastfeeding
• Recovering from a heart attack
• Under 25 years old (due to mental health risks)

Trazodone may not be appropriate for people who have certain psychiatric illnesses, including bipolar disease and schizophrenia. Check with your doctor if you have heart disease, cerebrovascular disease (affecting blood flow in the brain), seizures, or kidney or liver problems.

Trazodone also has the potential to interact with many other drugs. Your medications should be carefully reviewed by your healthcare provider before you start to take trazodone.

Dosage

Your healthcare providers starts with a low dose and increases it if the medication doesn’t help. For insomnia, trazodone is used in doses of 50 mg or 100 mg.

However, it’s also available in tablets pf 150 mg and 300 mg doses. Extended release trazodone comes in 150 mg and 300 mg doses.

How Long Before Trazodone Works?

Trazodone produces different effects depending on the dose. The low dose used for insomnia usually works within 30 minutes. By comparison, a higher dose for depression doesn’t take hold for up to four weeks.

When to Check With Your Healthcare Provider

Consult your healthcare provider when you struggle to get a good night’s sleep, wake up still feeling tired, or feel drowsy and unable to concentrate during the day.

Long-lasting insomnia disrupts your sleep, which leads to health problems such as:

Talk with your healthcare provider if you experience any side effects, whether due to trazodone or insomnia.

Summary

Trazodone is an antidepressant that’s also used for sleep problems because it makes you drowsy. However, the American Academy of Sleep Medicine does not recommend it as a first-line treatment for insomnia. This medication may not be safe for some people to use, especially children and those who have heart disease, psychiatric illnesses, or are pregnant or breastfeeding.

Trazodone can also cause side effects like dry mouth, dizziness, nausea, and high blood pressure. Though uncommon, trazodone can also cause serious problems like suicidal thoughts and behaviors, a painful erection, and an irregular heart rhythm. Talk with your healthcare provider about the possible side effects and whether it’s safe for you to take trazodone.