From the Guidelines
Sertraline and trazodone can be taken together, but this combination should only be used under medical supervision, with careful monitoring for symptoms of serotonin syndrome, especially in the first 24 to 48 hours after dosage changes, as noted in the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1. When prescribing this combination, it is essential to start with a low dose and increase the dose slowly, as recommended in the guideline 1. Some key points to consider when prescribing sertraline and trazodone together include:
- Sertraline is often taken in the morning at doses ranging from 50-200mg daily, while trazodone is typically taken in the evening at doses of 50-150mg to help with sleep.
- The combination requires careful monitoring because both medications affect serotonin levels, which theoretically increases the risk of serotonin syndrome, a rare but serious condition characterized by agitation, confusion, rapid heart rate, dilated pupils, muscle rigidity, and elevated temperature.
- Patients should watch for unusual side effects like confusion, muscle twitching, shivering, diarrhea, or headache, and seek immediate medical attention if these occur.
- Starting with lower doses and gradually increasing can help minimize side effects, as recommended in the guideline for managing Alzheimer's disease 1.
- This combination is often beneficial for patients who need both daytime depression management and help with sleep at night. It is crucial to prioritize the patient's safety and well-being when prescribing this combination, and to carefully weigh the potential benefits against the potential risks, as emphasized in the clinical practice guideline 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Combination of Sertraline and Trazodone
- The combination of sertraline and trazodone can increase the risk of serotonin syndrome, a potentially life-threatening condition caused by a toxic excess of serotonin 2, 3.
- Serotonin syndrome can present with symptoms such as neuromuscular excitation, autonomic instability, and altered mental status, and can be fatal if left unrecognized and untreated 2.
- There have been case reports of serotonin syndrome in patients taking sertraline and trazodone, often in combination with other medications such as atypical antipsychotics 2, 3.
Safety and Efficacy
- A comparative study found that trazodone and sertraline were equally effective in reducing depressive symptoms and promoting remission, with similar onset times 4.
- The study also found that trazodone may be a therapeutic option in the treatment of patients with major depression showing prevalent sleep disturbances 4.
- However, the combination of sertraline and trazodone can increase the risk of adverse reactions, including nervous system and gastrointestinal symptoms 4.
Mechanism of Action
- SSRIs, such as sertraline, work by increasing the levels of serotonin in the brain, which can help to improve mood and reduce symptoms of depression 5.
- Trazodone also increases the levels of serotonin in the brain, although its exact mechanism of action is not fully understood 4.
- The combination of sertraline and trazodone can increase the risk of serotonin syndrome due to the increased levels of serotonin in the brain 2, 3.