From the Guidelines
Trazodone can be used to help with anxiety, particularly in cases where sleep disturbances are also present, due to its sedative properties and ability to regulate mood and anxiety by affecting serotonin levels in the brain. The medication is often prescribed "off-label" for anxiety disorders, with typical starting doses ranging from 25-50mg taken at bedtime, which may be gradually increased to 100-300mg daily as needed and tolerated 1. It's essential to note that while trazodone can help with anxiety, it is not FDA-approved specifically for this purpose.
Key Considerations
- Trazodone's sedative effects can be beneficial for individuals experiencing anxiety with sleep disturbances.
- Side effects may include drowsiness, dizziness, dry mouth, and occasionally headaches, which is why it's often taken at night and started at lower doses.
- The full anti-anxiety benefits of trazodone may take 2-4 weeks to experience, though the sedative effects occur more quickly.
- Consultation with a healthcare provider is necessary to determine if trazodone is appropriate for a specific situation and medical history.
Evidence Summary
Research has shown that trazodone can improve sleep scores compared to other antidepressants like fluoxetine and venlafaxine 1. However, the evidence for its efficacy in treating anxiety specifically is limited, and it is generally considered when other treatments have failed or in conjunction with other therapies.
Clinical Decision Making
Given the potential benefits and the side effect profile, trazodone can be considered as an option for managing anxiety, especially when sleep disturbances are a significant component of the anxiety disorder. However, this decision should be made under the guidance of a healthcare provider, taking into account the individual's medical history, current medications, and specific needs.
From the Research
Trazodone and Anxiety
- Trazodone has been shown to be effective in treating anxiety symptoms in patients with major depressive disorder 2, 3.
- The drug has been investigated in various disorders, including anxiety disorders, and has been found to have efficacy as an anxiolytic 4.
- Trazodone's mechanism of action, which includes its effects on the serotoninergic system, may contribute to its anxiolytic properties 5.
- Studies have found that trazodone can be effective in reducing anxiety symptoms in patients with depression, and may be particularly helpful for patients with comorbid insomnia and anxiety 3, 6.
- Trazodone has been compared to other anxiolytic medications, such as diazepam and chlordiazepoxide, and has been found to have comparable efficacy in treating anxiety symptoms 6.
Clinical Use of Trazodone for Anxiety
- Trazodone is often prescribed off-label for anxiety disorders, and its use in this context is supported by clinical evidence 4, 3.
- The drug's pharmacological properties, including its low risk of anticholinergic side effects and weight gain, make it a potentially useful option for patients with anxiety disorders 3.
- Trazodone's efficacy in treating anxiety symptoms, combined with its relatively low risk of side effects, make it a viable treatment option for patients with major depressive disorder and comorbid anxiety 2, 3.