What is the therapeutic dose of trazodone (antidepressant)?

From the Guidelines

Trazodone is typically used as an antidepressant at doses of 150-400 mg per day, with most patients requiring at least 150 mg daily to achieve antidepressant effects. The treatment usually begins with a lower dose of 50-100 mg at bedtime, which is then gradually increased every 3-4 days until reaching the therapeutic antidepressant range. It's essential to note that at lower doses (25-100 mg), trazodone primarily acts as a sedative and is often prescribed for insomnia rather than depression. The antidepressant effect occurs at higher doses because trazodone needs to reach sufficient concentrations to inhibit serotonin reuptake in the brain, as suggested by the recommended therapeutic range of 650-1500 ng/mL 1. Patients should take the medication with food to reduce the risk of dizziness and lightheadedness, and the dose is often divided with the larger portion taken at bedtime to minimize daytime sedation while utilizing the sleep-promoting effects at night.

Some key points to consider when prescribing trazodone include:

• Starting with a low dose and gradually increasing it to minimize side effects
• Monitoring patient response and adjusting the dose as needed
• Being aware of the potential for sedation at lower doses and adjusting the timing of administration accordingly
• Considering the patient's medical history, current medications, and potential interactions when prescribing trazodone

It's also important to note that trazodone is not recommended as a first-line treatment for insomnia, as suggested by the American Academy of Sleep Medicine clinical practice guideline 1. However, it may be used off-label for this purpose in certain cases. The American College of Physicians clinical practice guideline for treating depressive disorders also recommends considering second-generation antidepressants, including trazodone, based on adverse effect profiles, cost, and patient preferences 1.

From the FDA Drug Label

An initial dose of 150 mg/day in divided doses is suggested. The dosage should be initiated at a low-dose and increased gradually, noting the clinical response and any evidence of intolerance. The dose may be increased by 50 mg/day every 3 to 4 days The maximum dose for outpatients usually should not exceed 400 mg/day in divided doses. Inpatients (i.e., more severely depressed patients) may be given up to but not in excess of 600 mg/day in divided doses.

The dose of trazodone antidepressant is 150 mg/day initially, and may be increased up to a maximum of 400 mg/day for outpatients or 600 mg/day for inpatients, in divided doses 2.

• The dose should be increased gradually, with increments of 50 mg/day every 3 to 4 days.
• Low-dose initiation is recommended, with adjustments based on clinical response and tolerance.

From the Research

Trazodone Dosage

• The appropriate antidepressant doses of trazodone are usually 150-300 mg/day 3
• Trazodone is often prescribed at higher doses when used as an antidepressant, compared to when it is used to augment the antidepressant effect of another medication or to address insomnia in a patient treated with an SSRI 3
• Extended-release trazodone has been evaluated at doses of 150-300 mg/day in patients with major depressive disorder and comorbid insomnia, anxiety, or psychomotor agitation 4

Efficacy and Safety

• Trazodone has been shown to be effective in reducing depressive symptoms, anxiety, and insomnia in patients with major depressive disorder 3, 5, 4
• Trazodone has a relatively low risk of side effects, such as weight gain, sexual dysfunction, and anticholinergic effects 3, 4
• Common adverse effects reported with trazodone include drowsiness, headache, dizziness, and dry mouth 6

Comparison to Other Antidepressants

• Trazodone has been compared to selective serotonin reuptake inhibitors (SSRIs) in several studies, with some studies suggesting that trazodone may be more effective in reducing depressive symptoms and improving sleep quality 5, 4
• Trazodone has also been compared to tricyclic antidepressants (TCAs) and other antidepressants, with some studies suggesting that it may have a more favorable side effect profile 3, 7