Can Trazodone (antidepressant) be taken as needed?

From the Guidelines

Trazodone should not be used as needed for insomnia due to its adverse effect profile and lack of strong evidence supporting its efficacy for this condition. According to the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines 1, the work group advised against the use of trazodone for treatment of chronic insomnia disorder. This recommendation was based on 4 fair-quality systematic reviews that evaluated the use of pharmacologic agents, including trazodone. Although trazodone was more effective at improving subjective sleep quality, there were no differences in sleep onset latency, total sleep time, or wake after sleep onset compared to placebo. The low-quality evidence supporting the efficacy of trazodone was outweighed by its adverse effect profile.

Some key points to consider when evaluating the use of trazodone for insomnia include:

• The medication can cause morning grogginess, dizziness, or low blood pressure when standing
• Trazodone should not be combined with alcohol or other central nervous system depressants
• Cognitive behavioral therapy for insomnia is recommended as first-line treatment before the initiation of sedating antidepressants like trazodone 1
• The American College of Physicians recommends that clinicians discuss the benefits and harms of pharmacologic treatments with patients and use shared decision-making to select therapies for chronic insomnia disorder 1

In terms of dosing, some healthcare providers may prescribe trazodone as needed at doses of 25-100mg taken 30-60 minutes before bedtime. However, it is essential to discuss this specifically with a healthcare provider to determine the best course of treatment and to minimize potential adverse effects. Overall, the evidence suggests that trazodone should be used with caution and only when the benefits outweigh the risks, and alternative treatments such as cognitive behavioral therapy for insomnia should be considered first.

From the FDA Drug Label

1. Dosage and Administration 2. 1 Dose Selection An initial dose of 150 mg/day in divided doses is suggested.

The FDA drug label does not answer the question.

From the Research

Trazodone as Needed

• Trazodone can be used as needed for insomnia, as evidenced by studies that demonstrate its efficacy in improving sleep quality and duration 2, 3.
• The medication is often prescribed at low doses (50-100mg) for insomnia, and its side effects are generally dose-dependent, with drowsiness being the most common 2, 3.
• However, trazodone may not be suitable for all patients, particularly older adults, as it can increase the risk of orthostatic hypotension, syncope, and falls 4.

Dosage and Administration

• The appropriate dosage of trazodone for insomnia can vary, but typical doses range from 50-100mg taken 30 minutes before bedtime 3, 5.
• Trazodone can be used in combination with cognitive behavioral therapy (CBT) to improve sleep outcomes in patients with primary insomnia 5.
• Higher doses of trazodone (150-300mg) are often used for the treatment of major depressive disorder, but lower doses may be sufficient for insomnia 6.

Safety and Efficacy

• Trazodone has been shown to be effective in improving sleep quality and duration in patients with primary insomnia, with few side effects reported 2, 3.
• However, trazodone can cause cognitive and motor impairments, particularly at higher doses, which may be a concern for patients who need to perform daily activities 3.
• The medication may also increase the risk of orthostatic hypotension, syncope, and falls in older adults, particularly those with hypertension 4.