Is Trazodone effective for treating fear of flying?

Trazodone is Not Recommended for Fear of Flying

Trazodone is not recommended for the treatment of fear of flying as there is insufficient evidence supporting its efficacy for this specific condition, and behavioral therapy approaches are considered first-line treatment. 1

Evidence on Trazodone for Fear of Flying

• There is no specific evidence supporting trazodone use for fear of flying in any of the reviewed guidelines or research 1, 2
• While trazodone has been used off-label for various anxiety disorders including Generalized Anxiety Disorder, Panic Disorder, and Post-Traumatic Stress Disorder, fear of flying is not among its established off-label uses 2
• Trazodone has significant side effects including daytime sedation, dizziness, headache, priapism, and orthostatic hypotension, which could be problematic during air travel 3

Recommended Approaches for Fear of Flying

First-Line: Behavioral Therapy

• Cognitive-behavioral therapy (CBT) approaches, particularly systematic desensitization, are the most effective and recommended treatments for fear of flying 1, 4
• Exposure therapy according to the reaction management model is indicated for patients whose fear of flying manifests as panic attacks 1
• Fear of flying treatment programs typically include an information component and a test flight as basic elements 5

Pharmacological Options (When Needed)

• SSRIs may be beneficial for fear of flying, particularly when comorbid with depression, as evidenced by case reports of fluoxetine successfully treating fear of flying 6
• Benzodiazepines are sometimes used short-term for specific flying phobia, though their effectiveness remains controversial 1
• Beta-blockers may help manage the physical symptoms of anxiety during flights 1

Specific Concerns with Trazodone in Air Travel Context

• The VA/DoD clinical practice guidelines specifically advise against trazodone for insomnia, noting that its adverse effect profile outweighs its limited efficacy 3
• Sedating effects of trazodone could impair a passenger's ability to respond appropriately during emergency situations 3
• The 2021 travel medicine guidelines recommend avoiding alcohol during flights as it may alter cognitive function and trigger anxious states - trazodone could potentially have similar effects 3
• 19% of patients in one study discontinued trazodone due to side effects including priapism, daytime sedation, more vivid nightmares, and severe dry mouth 3

Practical Recommendations for Managing Fear of Flying

• Seek specialized fear of flying treatment programs, which are available internationally through airlines and mental health professionals 5
• Consider booking flights at optimal times (late morning or early afternoon) to minimize disruption to daily routines 3
• Request assistance at airports if needed, and allow plenty of time before departure to reduce stress 3
• Inform cabin crew about anxiety concerns to raise awareness and avoid misunderstandings 3
• If medication is deemed necessary, discuss with a healthcare provider about short-term use of more evidence-based options like SSRIs or beta-blockers rather than trazodone 1, 6

Conclusion

Fear of flying requires a comprehensive assessment and primarily behavioral interventions. Trazodone lacks specific evidence for this condition and carries significant side effect risks that make it unsuitable for the air travel context. Cognitive-behavioral approaches remain the gold standard treatment.