Timing of Sertraline (Zoloft), Lurasidone (Latuda), and Trazodone Administration
Sertraline should be taken in the morning, while both lurasidone and trazodone should be taken at night.
Sertraline (Zoloft) - Morning Administration
- Sertraline is best administered in the morning because SSRIs like sertraline can disrupt sleep architecture and cause activating effects 1.
- If insomnia develops during SSRI treatment, it should be managed through sleep hygiene measures or adjunctive medications rather than switching to nighttime dosing, as nighttime administration will likely worsen sleep quality 1.
- Morning dosing of SSRIs increases slow-wave sleep, which is less disruptive to overall sleep quality compared to evening administration 1.
Lurasidone (Latuda) - Nighttime Administration
- Lurasidone should be taken at bedtime due to its beneficial sleep-promoting effects 2.
- Lurasidone significantly increases total sleep time (by approximately 28 minutes), decreases wake time after sleep onset, and improves sleep efficiency 2.
- The medication has specific sleep maintenance effects without negatively impacting sleep onset, REM sleep, or slow-wave sleep 2.
- Critical administration requirement: Lurasidone must be taken with food (at least 350 calories) to ensure adequate absorption, making it ideal to take with an evening meal or bedtime snack 3.
Trazodone - Nighttime Administration
- Trazodone is optimally dosed at bedtime based on its 3-9 hour half-life and pharmacokinetic profile 4.
- Single nighttime dosing produces better sleep with less daytime drowsiness compared to divided daily dosing, particularly at treatment onset 4, 5.
- Studies demonstrate equivalent antidepressant efficacy between single nighttime dosing and divided daily dosing, but nighttime administration reduces side effects like dry mouth, headache, and drowsiness 5.
- Trazodone improves sleep onset, sleep duration, and reduces early morning awakening when used as a sleep aid 6.
- The typical starting dose is 50-150 mg at bedtime, with increases to 200-300 mg as needed 4.
Important Caveats
- For trazodone: While commonly used off-label for insomnia, the American Academy of Sleep Medicine guidelines suggest clinicians NOT use trazodone for primary insomnia treatment due to limited evidence 7. However, it remains effective for antidepressant-associated insomnia 6 and is widely used clinically for sleep in psychiatric populations 7.
- Sedation monitoring: Approximately 60% of patients on trazodone experience some side effects, particularly daytime sedation or dizziness 7.
- Rare but serious trazodone risk: Priapism occurs in a small percentage of patients and requires immediate discontinuation 7.