Trazodone and Hallucinations
Yes, trazodone can cause hallucinations, as documented in the FDA drug label which lists hallucinations/delusions as a known adverse reaction. 1
Evidence of Trazodone-Induced Hallucinations
The FDA drug label for trazodone clearly identifies hallucinations/delusions as potential adverse reactions, occurring at an incidence of less than 2% in controlled clinical studies 1. This represents the most authoritative source on this medication's side effects.
Case reports further support this association:
- A documented case of auditory hallucinations specifically induced by trazodone in a 26-year-old female patient 2
- Trazodone-induced delirium with hallucinations in patients with pre-existing organic cerebral lesions or thyroid dysfunction 3
Risk Factors and Mechanisms
Several factors may increase the risk of hallucinations with trazodone:
- Pre-existing organic cerebral lesions 3
- Thyroid dysfunction 3
- Overdose situations 4
- Possible serotonergic effects through its metabolite meta-chlorphenylpiperazine, which has 5-HT agonistic properties 3
Clinical Presentation
Trazodone-induced hallucinations may present as:
- Auditory hallucinations (particularly at night) 2
- Visual hallucinations
- Hallucinations as part of a broader delirium picture 3
Management of Trazodone-Induced Hallucinations
When hallucinations occur with trazodone:
Discontinue trazodone - Case evidence shows that discontinuation leads to complete resolution of hallucinations 2
Consider alternative medications if treatment for depression, anxiety or insomnia is still needed:
- For depression: SSRIs, SNRIs, or other classes with lower risk of hallucinations
- For insomnia: Non-serotonergic sleep aids
Monitor for resolution - Hallucinations typically resolve after discontinuation of trazodone 2
Other Important Considerations
Trazodone has additional serious adverse effects that clinicians should be aware of:
- Cardiac arrhythmias including QT prolongation 1
- Orthostatic hypotension and syncope 1
- Serotonin syndrome when combined with other serotonergic agents 1
- Priapism 1
Special Populations
Elderly patients may be at higher risk for adverse effects, though they generally tolerate trazodone better than older tricyclic antidepressants 5. Maximum tolerated doses in the elderly are typically 300-400 mg/day, compared to up to 600 mg/day in younger patients 5.
Conclusion
While trazodone is generally considered safer than many other antidepressants, particularly in overdose situations 5, hallucinations are a recognized adverse effect that clinicians should monitor for, especially in patients with pre-existing risk factors such as organic brain lesions or thyroid dysfunction.