Trazodone is a prescription medication whose primary FDA-approved use is for major depressive disorder. However, its off-label use for insomnia now exceeds its primary use. It is also used for a number of other conditions. It is not a controlled substance. Read on to learn more about what it is, how it works, and what it’s used for.
What is Trazodone and How Does it Work?
Trazodone is in a class of medications called serotonin modulators. Specifically, it is a serotonin antagonist and reuptake inhibitor (SARI). It inhibits serotonin reuptake and antagonizes the serotonin receptors. This increases serotonin activity in the brain and thereby helps improve mood and symptoms of depression and anxiety. As well, it inhibits other receptors, which result in its sedative and low blood pressure effects.
What is Trazodone Prescribed For?
Primarily developed (and FDA-approved) to treat Major Depressive Disorder (MDD), the use of trazodone off-label for insomnia now exceeds that of MDD. Other main off-label uses include [1]:
- Schizophrenia (not monotherapy; only when used as an adjunct to antipsychotic medications)
- Alcohol dependence
- Erectile Dysfunction
- Sleep disorders
- Post-traumatic Stress Disorder (as a second-line treatment)
- Chronic pain disorders (fibromyalgia, diabetic neuropathy)
- Eating disorders
Other off-label uses include:
- Management of abnormal movements, e.g., dyskinesia from antipsychotics
- Alzheimer’s disease
- Dementia
- Gastrointestinal disorders
Is Trazodone Safe? Effects and Interactions
Yes, trazodone is generally safe when taken as prescribed. Your doctor will be aware of interactions with other drugs you may be taking (there are many possible interactions). Currently, trazodone is a last-line measure for MDD, compared to alternative available drugs. Talk to your doctor about eating grapefruit and drinking grapefruit juice while taking this medicine.
There is increased probability of problems, such as suicidal thinking and behavior in children, adolescents, and young adults (under 24 years of age) taking antidepressants to treat major depressive disorders and other psychiatric diseases and conditions.
Common side effects include the following. Other, more severe side effects should be referred to your doctor [2]:
| Fatigue | Drowsiness | Somnolence |
| Nausea | Vomiting | Diarrhea |
| Constipation | Changes in appetite/weight | Weakness or tiredness |
| Nervousness | Dizziness/light headedness | Nightmares |
| Muscle pain | Dry mouth | Rash/Red or itchy eyes |
| Sexual problems | Uncontrollable shaking | Stuffy nose |
When Should You Not Take Trazodone
Trazodone therapy requires careful consideration for patients treated with monoamine oxidase inhibitors (MAOIs), including linezolid or intravenous methylene blue. Do not take trazodone if you are currently using monoamine oxidase inhibitors (MAOIs), or have used them in the past 14 days, due to the risk of dangerous interactions and serotonin syndrome.
You should not take trazodone if you have any of the following conditions. Discuss these with your doctor [3] [4]:
- Heart conditions
- Liver or kidney impairment
- History of mania or bipolar disorder
- Narrow-angle glaucoma
- Epilepsy or seizure disorders
- Children and teens under 18
- Pregnancy and breastfeeding
- Risk of suicide
- Allergy
Safe Trazodone Alternatives
There is a wide variety of alternatives for MDD and sleep issues. Consult with your doctor.
Do not take alternatives to trazodone, including some herbal supplements like St. John’s wort, or they may cause serious problems with serotonin syndrome and heart problems.
Always tell your healthcare provider about your full medical history and any new supplements you may be taking before starting trazodone. Never start or stop trazodone without consulting your doctor.
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Sources
[1] MedCentral. 2024. Trazodone Oral.
[2] MedLinePlus. 2022. Trazodone.
[3] Shin JJ, Saadabadi A. Trazodone. [Updated 2024 Feb 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing
[4] Rath, K. 2024. Trazodone oral tablet interactions: Alcohol, medications, and other factors. MedicalNewsToday.
Author
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I am a Licensed Clinical Social Worker and graduated with a degree from the USC School of Social Work in 2015 with an emphasis in mental health. I began my career working with the Orange County Welfare to Work Program providing mental health services to reduce barriers to employment. I have spent the last 5 years working various levels in behavioral health, providing direct service to those struggling with co-occurring disorders. Using an eclectic and integrative approach, I incorporate the AIP model with EMDR, Person-in-Environment (PIE), Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), family systems, interpersonal and solution-focused therapy along with Rogerian positive regard into my practice.
