From the Guidelines
Trazodone is not recommended for the treatment of chronic insomnia disorder due to its adverse effect profile and limited efficacy. The most recent and highest quality study, published in 2020 in the Annals of Internal Medicine 1, found that the benefits of trazodone for insomnia did not outweigh its potential harms. 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 study also noted that the low-quality evidence supporting the efficacy of trazodone was outweighed by its adverse effect profile.
Mechanism of Action
Trazodone works by blocking certain serotonin receptors in the brain, which produces a sedative effect. However, its use for insomnia is not supported by strong evidence, and its adverse effects, such as dizziness, dry mouth, and morning drowsiness, can outweigh its benefits.
Alternative Treatments
Instead of trazodone, other treatments for insomnia may be considered, such as cognitive behavioral therapy for insomnia (CBT-I) or other non-pharmacological interventions. The 2008 guideline from the Journal of Clinical Sleep Medicine 1 recommends CBT-I as a standard treatment for chronic insomnia, and also suggests other therapies such as stimulus control, relaxation training, and sleep restriction.
Conclusion is not allowed, so the answer will be ended here, prioritizing the patient's morbidity, mortality, and quality of life.
From the FDA Drug Label
- Clinical Pharamcology 12. 1 Mechanism of Action The mechanism of trazodone’s antidepressant action is not fully understood, but is thought to be related to its enhancement of serotonergic activity in the CNS
- 2 Pharmacodynamics Preclinical studies have shown that trazodone selectively inhibits neuronal reuptake of serotonin (Ki = 367 nM) and acts as an antagonist at 5-HT-2A (Ki = 35.6 nM) serotonin receptors.
The FDA drug label does not answer the question.
From the Research
Mechanism of Action
- Trazodone is an antidepressant with a unique mechanism of action that makes it effective in treating depression and insomnia 2.
- It has a favorable profile for the treatment of depression, with a low risk of anticholinergic side effects, weight gain, and sexual side effects 2.
- Trazodone's sedating properties make it a popular choice for treating insomnia, particularly in patients with major depressive disorder 3, 4, 5.
Efficacy in Insomnia
- Studies have shown that trazodone is effective in treating primary and secondary insomnia, including symptoms that are a result of depression, dementia, and other conditions 3, 6.
- Trazodone has been found to be efficacious in more than 60% of patients with chronic insomnia, with no significant difference in efficacy compared to other sedating antidepressants like mirtazapine 6.
- Low doses of trazodone (25-50 mg) have been found to be effective in treating insomnia, with higher doses (100-150 mg) associated with a higher risk of side effects 3, 6.
Side Effects and Safety
- The most common side effect of trazodone is drowsiness, which is dose-dependent 3.
- Other side effects associated with trazodone include sedation, dizziness, and psychomotor impairment, which can be a concern in elderly patients 4.
- Trazodone has a relatively low risk of side effects compared to other antidepressants, making it a popular choice for treating insomnia and depression 2.
Clinical Practice
- Trazodone is often prescribed in low doses (25-50 mg) to promote sleep, as an alternative to hypnotics 5.
- The appropriate antidepressant doses of trazodone are usually 150-300 mg/day, which are often higher than the doses used to treat insomnia 2.
- Trazodone may be helpful for patients with major depression and comorbid insomnia, anxiety, or psychomotor agitation 2.