Does Trazodone (an antidepressant medication) require a taper?

From the Guidelines

Trazodone typically does not require a taper for most patients, but a gradual taper is recommended for those on higher doses or long-term use to minimize discontinuation symptoms. When considering the discontinuation of trazodone, it's essential to weigh the potential risks and benefits, particularly in the context of morbidity, mortality, and quality of life. According to a study published in The Lancet Psychiatry 1, there is evidence to suggest that antidepressants, including trazodone, can be associated with withdrawal symptoms upon discontinuation. The study found that patients taking antidepressants had a higher risk of withdrawal syndrome, vertigo, dizziness, and suicidal ideation compared to those receiving placebo.

Some key points to consider when discontinuing trazodone include:

• The risk of withdrawal symptoms is higher in patients who have been taking trazodone for extended periods or at higher doses.
• A gradual tapering schedule, such as reducing the dose by 25-50 mg every 3-7 days, can help minimize discontinuation symptoms.
• Patients who experience significant discontinuation symptoms, such as anxiety, irritability, insomnia, headache, or dizziness, should contact their healthcare provider for guidance.
• It's crucial to consult with a healthcare provider before stopping or changing any medication regimen, as individual circumstances may vary.

In terms of specific guidance, the study suggests that patients who have been taking trazodone for short periods or at lower doses may not require a taper, while those on higher doses or long-term use should undergo a gradual taper to minimize the risk of discontinuation symptoms. Ultimately, the decision to taper trazodone should be made in consultation with a healthcare provider, taking into account the individual patient's circumstances and medical history.

From the FDA Drug Label

Discontinuation Syndrome Advise patients not to abruptly discontinue Trazodone Hydrochloride Tablets and to discuss any tapering regimen with their healthcare provider. Adverse reactions can occur when Trazodone Hydrochloride Tablets are discontinued [see Warnings and Precautions (5. 8)]. Never stop an antidepressant medicine without first talking to a healthcare provider. Stopping an antidepressant medicine suddenly can cause other symptoms.

Trazodone discontinuation requires a taper. Patients should not stop taking Trazodone Hydrochloride Tablets abruptly and should discuss a tapering regimen with their healthcare provider to avoid adverse reactions 2, 2.

From the Research

Trazodone Tapering

• Trazodone withdrawal symptoms can occur despite gradual discontinuation of therapeutic doses, suggesting that a very slow taper rate is necessary 3.
• The development of trazodone withdrawal symptoms is thought to be related to the effects of trazodone and its metabolite on the serotonergic system, which may result in noradrenergic rebound after discontinuation 3.
• A study on benzodiazepine discontinuation found that trazodone did not have a significant effect on withdrawal severity, but it did improve taper success rates at the 5-week assessment 4.

Clinical Practice Guidelines

• Current clinical practice guidelines provide little support for clinicians wishing to help patients discontinue or taper antidepressants, including trazodone, in terms of mitigating and managing withdrawal symptoms 5.
• Most guidelines recommend gradual or slow tapering of antidepressants, but none provide guidance on dose reductions, distinguishing withdrawal symptoms from relapse, or managing withdrawal symptoms 5.

Patient Experiences

• Patients who experience antidepressant withdrawal symptoms, including those from trazodone, are often dismissed or misdiagnosed with relapse or a new medical condition 6.
• Patients may seek advice outside of mainstream healthcare, including online forums, due to a lack of information and support from healthcare providers 6.

Pharmacological Treatment

• Trazodone may be effective in treating depression accompanied by sleeping disorders and has shown efficacy in alcohol and benzodiazepine dependency 7.
• The use of trazodone in treating patients with addiction problems and comorbid depression may improve the efficacy of detoxification and treatment, and decrease the risk of benzodiazepine dependency 7.