From the Guidelines
Trazodone should not be used as a first-line treatment for insomnia due to its adverse effect profile and limited efficacy, as evidenced by 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 1.
The use of trazodone for insomnia is not recommended due to several factors. Firstly, the evidence supporting its efficacy is of low quality and is outweighed by its adverse effect profile, which includes risks such as dependency, diversion, falls, and cognitive impairment in older patients, as well as hypoventilation in patients with respiratory conditions 1.
Additionally, trazodone has been found to have no differences in sleep onset latency, total sleep time, or wake after sleep onset compared to placebo in patients with chronic insomnia, despite improving subjective sleep quality 1.
The American College of Physicians recommends that clinicians choose pharmacologic therapy for patients with acute major depression based on adverse effect profiles, cost, and patient preferences, and trazodone is not a preferred option due to its side effects 1.
In terms of treatment for depression, trazodone is still an option, but its use should be carefully considered due to its potential side effects. For depression, doses usually start at 150mg daily, divided into multiple doses, and may be increased gradually to 400mg daily. Common side effects include drowsiness, dizziness, dry mouth, and headache. More serious but rare side effects include priapism (prolonged erection) in men, which requires immediate medical attention.
Overall, the potential harms and adverse effects of trazodone, particularly in the context of insomnia treatment, outweigh its benefits, and alternative treatments should be considered. The most recent and highest quality study, published in 2020, advises against the use of trazodone for chronic insomnia disorder due to its adverse effect profile 1.
From the FDA Drug Label
Trazodone Hydrochloride Tablets are indicated for the treatment of major depressive disorder (MDD) in adults. The primary use of Trazodone is for the treatment of major depressive disorder (MDD) in adults.
- Key points about Trazodone include:
- It is a prescription medicine used to treat MDD in adults
- It belongs to a class of medicines known as SSRIs (or selective serotonin reuptake inhibitors)
- It is not known if Trazodone Hydrochloride Tablets are safe and effective in children 2
- 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
From the Research
Trazodone Overview
- Trazodone is a triazolopyridine serotonin receptor antagonist and reuptake inhibitor (SARI) antidepressant approved for major depressive disorder (MDD) in adults 3, 4.
- It has established efficacy comparable to other available antidepressants and is effective for a range of depression symptoms, including insomnia 3, 5.
Efficacy and Benefits
- Trazodone is effective in controlling a wide range of symptoms of depression, while avoiding the negative effects on sleep seen with SSRI antidepressants 4, 5.
- It has a low liability for activating side effects, and its efficacy on symptoms such as insomnia and psychomotor agitation makes it useful for many depressed patients 3, 6.
- Trazodone may be helpful for patients with major depression and comorbid insomnia, anxiety, or psychomotor agitation 5, 6.
Side Effects and Tolerability
- The most common adverse effects of trazodone are somnolence, headache, dizziness, and xerostomia 3, 4.
- Trazodone has minimal anticholinergic activity but may be associated infrequently with orthostatic hypotension, QT interval prolongation, cardiac arrhythmias, and rare episodes of priapism 3, 4.
- It has a low risk of anticholinergic side effects, weight gain, and sexual side effects 5.
Dosage and Formulation
- The appropriate antidepressant doses of trazodone are usually 150-300 mg/day 5.
- A once-daily formulation of trazodone has been developed, which may provide improved tolerability over the conventional immediate-release formulation 4, 7.
- The once-a-day formulation of trazodone has an improved tolerability profile and exhibits antidepressant activity at a starting dose of 150 mg/day 7.