From the Guidelines
Trazodone should not be prescribed as a first-line treatment for insomnia due to its limited efficacy and potential risks, as recommended by the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines 1. The guidelines advise against the use of trazodone for chronic insomnia disorder, citing low-quality evidence supporting its efficacy and significant adverse effects. Instead, cognitive behavioral therapy for insomnia (CBT-I) and other non-pharmacological approaches should be considered as initial treatments.
- The American Academy of Sleep Medicine recommends CBT-I as a standard treatment for chronic insomnia, which includes stimulus control, relaxation training, and sleep restriction 1.
- Pharmacological treatments, such as benzodiazepine receptor agonistic modulators, melatonin receptor agonists, and sedating antidepressants, may be considered for patients who have not responded to non-pharmacological treatments or have comorbid conditions 1.
- When prescribing trazodone, it is essential to monitor for side effects, including sedation, dizziness, orthostatic hypotension, and priapism in males, and to use caution in patients with cardiac conditions 1.
- Trazodone may be considered for patients with comorbid depression or anxiety disorders, but its use should be carefully weighed against potential risks and benefits.
- The medication should be used at the lowest effective dose and for the shortest possible duration to minimize adverse events.
From the FDA Drug Label
Trazodone Hydrochloride Tablets are a prescription medicine used in adults to treat major depressive disorder (MDD).
The appropriate diagnosis for prescribing trazodone is Major Depressive Disorder (MDD) in adults.
- Key points to consider before prescribing trazodone include:
- Screening patients for any personal or family history of bipolar disorder, mania, or hypomania.
- Evaluating the patient's medical history, including heart problems, liver or kidney problems, and other serious medical conditions.
- Discussing all treatment choices with the patient, including the risks and benefits of treatment with antidepressant medicines. 2
From the Research
Appropriate Diagnosis for Prescribing Trazodone
Trazodone is prescribed for the treatment of major depressive disorder (MDD) in adult patients 3, 4, 5. The appropriate diagnosis for prescribing trazodone includes:
- Major depressive disorder (MDD) 3, 4, 5
- Depression with insomnia 3, 4, 5, 6
- Anxiety 4, 6
- Psychomotor agitation 4, 5
- Suicidality 6
Trazodone Dosage and Formulation
The appropriate antidepressant doses of trazodone are usually 150-300 mg/day 5. Trazodone can be prescribed as monotherapy or as part of a combination strategy 3, 4, 5. The once-daily formulation of trazodone has an improved tolerability profile compared to its conventional formulations 7, 6.
Efficacy and Tolerability of Trazodone
Trazodone has established efficacy comparable to other available antidepressants, including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin-noradrenaline (norepinephrine) reuptake inhibitors (SNRIs) 3, 4. Trazodone is well-tolerated and has a low risk of anticholinergic side effects, weight gain, and sexual side effects 3, 4, 5. The most common adverse effects of trazodone are somnolence, headache, dizziness, and xerostomia 3, 4.