Trazodone Is Not Addictive
Trazodone does not cause addiction or dependence in patients without a history of substance abuse. The FDA drug label explicitly states that trazodone is not a controlled substance, and clinical studies have shown no indication of drug-seeking behavior 1.
Official Classification and Regulatory Status
- Trazodone is not classified as a controlled substance by the FDA, distinguishing it from medications with abuse potential such as benzodiazepines and opioids 1.
- The FDA label specifically notes that "no indication of drug-seeking behavior was seen in the clinical studies with trazodone hydrochloride" 1.
Contrast with Addictive Medications
- Unlike benzodiazepines, which carry significant risks for abuse, addiction, and tolerance, trazodone is considered a safer alternative for treating insomnia and anxiety 2.
- The 2019 Lancet Psychiatry guideline identifies benzodiazepines, Z-drugs, and opioids as medications associated with dependence and withdrawal, but antidepressants including trazodone are explicitly stated as "not associated with a risk of dependence" 2.
- Clinical guidelines from multiple sources recommend trazodone as preferable to benzodiazepines specifically because benzodiazepines carry risks of dependency, diversion, falls, and cognitive impairment 3.
Clinical Evidence Supporting Low Abuse Potential
- Systematic preclinical and clinical studies have not demonstrated abuse potential for trazodone, and it has been used successfully in treating patients with alcohol and benzodiazepine dependence without causing secondary addiction 1, 4.
- Research indicates trazodone has "low abuse potential" and can be safely used in populations with substance use disorders, including for detoxification support 5, 4.
- Multiple clinical trials spanning decades have not identified drug-seeking behavior or addiction patterns with trazodone use 6, 7, 8.
Withdrawal Considerations
- While the 2019 Lancet guideline notes that antidepressants can cause withdrawal symptoms upon abrupt discontinuation, this is distinct from addiction or dependence 2.
- Withdrawal symptoms reflect physiological adaptation to medication, not the compulsive drug-seeking behavior that characterizes addiction 2.
- Trazodone's withdrawal profile is less problematic than SSRIs like paroxetine or venlafaxine, which are more commonly associated with discontinuation symptoms 2.
Safety in Vulnerable Populations
- Trazodone can be safely prescribed to patients with depression and comorbid addiction problems without increasing risk of developing new substance dependencies 4.
- The medication has been used therapeutically to treat benzodiazepine and alcohol dependence, demonstrating its safety profile even in addiction-prone populations 4.
- Clinical experience shows trazodone may actually decrease relapse risk in substance-dependent patients by improving sleep and mood without causing dependency 4.
Common Pitfalls to Avoid
- Do not confuse sedation with addiction potential - trazodone's sedative effects are therapeutic for insomnia but do not indicate abuse liability 5, 8.
- Do not withhold trazodone from patients with past substance use history - the evidence supports its safety in this population 4.
- Be aware that while trazodone is safe from an addiction standpoint, it does carry other risks including orthostatic hypotension, cardiac arrhythmias, and rare priapism that require monitoring 6, 8.