Is trazodone (an antidepressant medication) effective for treating insomnia?

From the Guidelines

Trazodone is not recommended as a first-line treatment for insomnia due to its limited efficacy and potential adverse effects. The most recent and highest quality study, published in 2020 in the Annals of Internal Medicine 1, advises against the use of trazodone for the treatment of chronic insomnia disorder. This recommendation is based on a systematic review that found no differences in sleep efficiency or rate of discontinuation due to adverse events between trazodone and placebo in patients diagnosed with chronic insomnia. 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.

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

• The potential for adverse effects, such as dizziness, dry mouth, and morning drowsiness
• The limited efficacy of trazodone in improving sleep outcomes, particularly in comparison to other treatments
• The importance of considering alternative treatments, such as cognitive behavioral therapy for insomnia (CBT-I) or other pharmacologic agents, that may be more effective and have a more favorable safety profile

It's also worth noting that other studies, such as the 2017 clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults published in the Journal of Clinical Sleep Medicine 1, also suggest that trazodone should not be used as a treatment for sleep onset or sleep maintenance insomnia in adults. Overall, the evidence suggests that trazodone is not a recommended treatment for insomnia, and alternative options should be considered.

From the Research

Efficacy of Trazodone for Insomnia

• Trazodone has been shown to be effective in improving sleep maintenance difficulties, with significant reductions in night-time awakenings and minutes of Stage 1 sleep 2.
• A study found that trazodone, when combined with cognitive behavior therapy (CBT), resulted in significant improvements in sleep latency, sleep efficiency, and total sleep time, as well as an increase in slow wave sleep duration 3.
• Trazodone has also been found to be effective in lengthening total sleep time and reducing salivary cortisol levels in patients with insomnia, particularly in those with objective short sleep duration 4.
• A systematic review of 45 studies found evidence for the efficacy of trazodone in treating primary and secondary insomnia, with the most common side effect being drowsiness 5.

Safety and Side Effects of Trazodone

• Trazodone has been associated with cognitive and motor impairments, including impairments in short-term memory, verbal learning, equilibrium, and arm muscle endurance 2.
• Side effects of trazodone are dose-dependent, with the most common being drowsiness, sedation, dizziness, and psychomotor impairment 5, 6.
• There is also evidence of tolerance related to the use of trazodone, which may limit its long-term effectiveness 6.

Comparison with Other Treatments

• Trazodone has been found to be more effective than CBT in improving objective sleep duration and reducing hypothalamic-pituitary-adrenal axis activation in patients with insomnia and objective short sleep duration 4.
• A review of 18 studies found that the evidence for the efficacy of trazodone in treating insomnia is limited, and that its use may be associated with a high incidence of discontinuation due to side effects 6.