What dose of trazodone (antidepressant medication) is effective for managing anxiety and depression, beyond its sedative effects for sleep?

Trazodone Dosing for Anxiety and Depression (Not Just Sleep)

For antidepressant and anxiolytic effects in anxiety and depression, trazodone requires doses of 150-300 mg daily, which is substantially higher than the 25-50 mg typically used for insomnia alone. 1, 2, 3, 4

Starting and Titrating to Therapeutic Doses

• Initial dose should be 150 mg/day in divided doses, as specified by the FDA label, not the 25-50 mg used for sleep 2

• Increase by 50 mg every 3-4 days based on clinical response and tolerability 2

• Target therapeutic range is 150-300 mg/day for full antidepressant efficacy in outpatients 1, 2, 3, 4

• Maximum outpatient dose is 400 mg/day in divided doses; inpatients with severe depression may receive up to 600 mg/day 2

Dosing Strategy for Optimal Effect

• Administer the dose predominantly at bedtime (though not necessarily all of it) to leverage trazodone's 3-9 hour half-life while minimizing daytime sedation 3

• Take shortly after a meal or light snack to optimize absorption 2

• Single nighttime dosing at therapeutic levels (150-300 mg) provides equal antidepressant efficacy compared to multiple daily doses, with better sleep and less daytime drowsiness during initial treatment 3

Timeline for Therapeutic Response

• Allow at least 4-8 weeks at the therapeutic dose before concluding treatment failure 1, 4

• The anxiolytic effects may appear earlier than full antidepressant response, as demonstrated in comparative trials showing both antidepressive and anxiolytic efficacy 5

Critical Distinction from Sleep-Only Dosing

The evidence clearly differentiates trazodone's use as an antidepressant versus a sleep aid:

• Low doses (25-50 mg) used for insomnia are subtherapeutic for depression and anxiety 1

• Antidepressant doses (150-300 mg) are often higher than augmentation doses when trazodone is added to SSRIs solely for sleep 4

• At therapeutic antidepressant doses, trazodone acts as both a serotonin antagonist and agonist, providing broader spectrum effects on depression, anxiety, and insomnia simultaneously 6, 4, 7

Advantages at Therapeutic Doses

• Trazodone at 150-300 mg effectively treats depression with comorbid insomnia, anxiety, or psychomotor agitation 4

• Significantly fewer anticholinergic side effects compared to tricyclic antidepressants 7

• Low risk of sexual dysfunction and weight gain compared to SSRIs 6, 4

• Safe in overdose compared to tricyclic antidepressants 7

Monitoring Considerations

• Use caution in patients with premature ventricular contractions and monitor for orthostatic hypotension during titration 1

• After 9 months of treatment, consider dose reduction to reassess continued need for medication 1

• Taper over 10-14 days when discontinuing to limit withdrawal symptoms 1