Can I add Trazodone (triazolopyridine) 25mg for sleep in an adult patient with a history of mental health issues, currently taking Sertraline (Zoloft) 200mg, Buspirone (Buspar) 30mg twice daily (bid), and Bupropion (Wellbutrin) 150mg bid?

Adding Trazodone to Your Current Psychiatric Regimen

I would not recommend adding trazodone 25mg for sleep to this medication regimen, as the American Academy of Sleep Medicine explicitly advises against using trazodone for insomnia treatment due to low-quality evidence and the risk of serotonin syndrome when combined with serotonergic medications like your current sertraline. 1

Why Trazodone Is Not Recommended Here

Guideline Position Against Trazodone

• The American Academy of Sleep Medicine has issued a formal recommendation against using trazodone for either sleep onset or sleep maintenance insomnia in adults, based on trials using 50mg doses (double your proposed dose) that showed very low evidence quality 1
• The 2008 guideline specifically states that trazodone's efficacy for insomnia is "not well established" despite some moderate effects in isolated studies 1

Serotonin Syndrome Risk

• You are already taking sertraline 200mg (a high dose SSRI), which creates a significant serotonergic burden 1
• Adding trazodone, which is both a serotonin reuptake inhibitor and 5-HT2A/5-HT2C receptor antagonist, increases your risk of serotonin syndrome 2
• The American Academy of Child and Adolescent Psychiatry specifically warns about combining multiple serotonergic agents, as serotonin syndrome can progress to seizures, arrhythmias, and unconsciousness 1
• A documented case report exists of a patient on bupropion, trazodone, and quetiapine who developed serotonin syndrome, demonstrating this exact combination carries real risk 3

Better Alternatives for Your Sleep Problem

First-Line Sleep Medications (Safer Options)

The American Academy of Sleep Medicine recommends these evidence-based alternatives that won't add serotonergic burden 1:

For sleep onset insomnia:

• Zaleplon 10mg 1
• Ramelteon 8mg 1
• Triazolam 0.25mg 1

For both sleep onset and maintenance insomnia:

• Eszopiclone 2-3mg 1
• Zolpidem 10mg 1
• Temazepam 15mg 1
• Suvorexant 10-20mg 1
• Doxepin 3-6mg 1

Optimize Your Current Medications First

Before adding any sleep medication, address this common pitfall:

• The American Academy of Family Physicians recommends giving the second dose of bupropion before 3 PM to minimize insomnia risk 1
• If you're taking your second bupropion 150mg dose later in the day, this could be causing or worsening your insomnia 1
• Bupropion is known to cause insomnia as a common adverse effect due to its activating properties 2, 4

Clinical Pitfalls to Avoid

• Never use diphenhydramine (Benadryl) or other antihistamines for chronic insomnia - the American Academy of Sleep Medicine explicitly recommends against this 1
• Do not abruptly discontinue sertraline if you decide to change medications, as this causes discontinuation syndrome 1
• Your current combination of sertraline and buspirone is safe and appropriate for anxiety and depression 1
• Buspirone does not cause tolerance, addiction, or cognitive impairment like benzodiazepines 1