Can trazodone cause next‑day depression in an adult taking it at night for insomnia, particularly at low doses or with rapid dose escalation?

Can Trazodone Cause Next-Day Depression?

Trazodone does not cause next-day depression as a direct pharmacologic effect; however, it produces measurable next-day cognitive and psychomotor impairment—including daytime drowsiness, dizziness, memory deficits, and equilibrium problems—that may be misinterpreted as worsening mood or may exacerbate functional impairment in patients already struggling with depression.

Evidence on Next-Day Effects

Documented Cognitive and Motor Impairment

• A randomized, double-blind, placebo-controlled trial in primary insomniacs (n=16) demonstrated that trazodone 50 mg produced small but statistically significant impairments in short-term memory, verbal learning, equilibrium (anterior/posterior body sway), and arm muscle endurance the morning after administration. 1

• These impairments persisted across both day 1 and day 7 of treatment, indicating that tolerance to these effects does not develop with continued use. 1

• The same study found that patients often do not perceive the degree of their own impairment, raising safety concerns about activities requiring full alertness (e.g., driving, operating machinery). 1

Dose-Dependent Sedation Profile

• The most common adverse effect of trazodone is dose-dependent drowsiness, which occurs more frequently at doses ≥100 mg/day but is still present at lower hypnotic doses (25–50 mg). 2

• In older adults, trazodone 50 mg was associated with adverse events in approximately 75% of participants (versus 65% on placebo), with headache in ~30% and somnolence in ~23%. 3

• The FDA label explicitly warns that patients may feel drowsy after taking trazodone and advises discussing dose or timing adjustments with a healthcare provider if this occurs. 4

Why Trazodone Is Not Recommended for Insomnia

Guideline Position

• The American Academy of Sleep Medicine issues a WEAK recommendation AGAINST using trazodone for sleep-onset or sleep-maintenance insomnia, concluding that potential harms outweigh the modest benefits. 3

• Clinical trials showed that trazodone 50 mg produced only minimal, clinically insignificant improvements: approximately 10 minutes shorter sleep latency, 22 minutes longer total sleep time, and 8 minutes less wake after sleep onset—with no improvement in subjective sleep quality. 35

• The VA/DOD guidelines explicitly advise against trazodone for chronic insomnia disorder, citing low-quality evidence and an adverse-effect profile that outweighs any benefit. 3

Specific Concerns at Low Doses

• When used at hypnotic doses (25–50 mg), trazodone is insufficient for treating comorbid major depression (which requires 150–300 mg/day for antidepressant effect). 36

• This creates a clinical dilemma: the dose needed for sleep is too low to treat depression, yet the dose needed for depression may produce unacceptable daytime sedation. 36

Preferred Alternatives for Insomnia

First-Line Non-Pharmacologic Therapy

• Cognitive Behavioral Therapy for Insomnia (CBT-I) must be offered before any medication; it demonstrates superior long-term efficacy with sustained benefits after discontinuation. 35

Second-Line FDA-Approved Pharmacotherapy

Indication	Agent (Dose)	Key Advantage
Sleep maintenance	Low-dose doxepin 3–6 mg	Reduces wake after sleep onset by 22–23 min; minimal anticholinergic effects; no abuse potential [3][5]
Sleep onset + maintenance	Eszopiclone 2–3 mg (1 mg if ≥65 y)	Increases total sleep time by 28–57 min; moderate-to-large improvement in sleep quality [3][5]
Sleep onset + maintenance	Zolpidem 10 mg (5 mg if ≥65 y)	Shortens sleep latency by ~25 min; adds ~29 min to total sleep time [3][5]
Sleep onset only	Zaleplon 10 mg (5 mg if ≥65 y)	Very short half-life (~1 h); minimal next-day sedation [3][5]
Sleep onset (substance-use history)	Ramelteon 8 mg	Zero addiction potential; no DEA scheduling; no withdrawal [3][5]

Clinical Bottom Line

• Trazodone does not cause depression per se, but its next-day cognitive and psychomotor effects—daytime drowsiness, memory impairment, dizziness, and equilibrium problems—can worsen functional capacity and may be mistaken for worsening mood. 1

• At low doses (25–50 mg), trazodone is ineffective for treating depression and provides only marginal sleep benefit with significant adverse effects. 36

• Guideline bodies recommend AGAINST trazodone for primary insomnia, favoring CBT-I as first-line therapy and FDA-approved hypnotics (low-dose doxepin, eszopiclone, zolpidem, zaleplon, ramelteon) as second-line options. 35

• If a patient on trazodone reports feeling "depressed" the next day, clinicians should assess for residual sedation, cognitive slowing, and psychomotor impairment rather than assuming worsening of the underlying mood disorder. 1