Trazodone: Effective Relief for Depression and Sleep Disorders
Trazodone
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Synonyms | |||
Trazodone hydrochloride is an antidepressant medication belonging to the class of serotonin antagonist and reuptake inhibitors (SARIs). It is primarily indicated for the treatment of major depressive disorder (MDD) and is widely used off-label for insomnia management due to its sedative properties. With a well-established safety profile and decades of clinical use, trazodone offers a balanced approach to managing mood disorders while addressing common comorbid sleep disturbances. Its dual mechanism of action provides both antidepressant and hypnotic effects, making it a versatile option in psychiatric and primary care practice.
Features
- Chemical name: 2-[3-[4-(3-chlorophenyl)piperazin-1-yl]propyl]-[1,2,4]triazolo[4,3-a]pyridin-3(2H)-one hydrochloride
- Available formulations: Oral tablets (50 mg, 100 mg, 150 mg, 300 mg)
- Pharmacologic class: Serotonin antagonist and reuptake inhibitor (SARI)
- Half-life: Approximately 5–9 hours in biphasic elimination
- Metabolism: Hepatic, primarily via CYP3A4
- Excretion: Renal (70–75%) and fecal (20–25%)
Benefits
- Effective reduction of depressive symptoms through serotonin reuptake inhibition and 5-HT2A receptor antagonism
- Rapid improvement in sleep architecture and latency due to histamine H1 receptor blockade
- Lower risk of sexual side effects compared to SSRIs and SNRIs
- Minimal weight gain potential relative to other sedating antidepressants
- Useful for patients with comorbid anxiety and depression
- Flexible dosing allows for tailored treatment approaches
Common use
Trazodone is FDA-approved for the treatment of major depressive disorder (MDD) in adults. Its off-label uses include management of insomnia, anxiety disorders, and as an adjunct in chronic pain conditions. In psychiatric practice, it is frequently prescribed when patients experience SSRI-induced insomnia or when sedation is desirable. The medication is particularly valuable in geriatric psychiatry due to its favorable side effect profile compared to traditional tricyclic antidepressants. Many clinicians utilize lower doses (25–100 mg) for insomnia while employing higher doses (150–400 mg) for antidepressant effects.
Dosage and direction
Initial dosing: For depression, begin with 150 mg per day in divided doses. May increase by 50 mg per day every 3–4 days based on response and tolerance. Maximum recommended dose is 400 mg per day for outpatients and 600 mg per day for inpatients.
Insomnia dosing: Typically 25–100 mg administered 30 minutes before bedtime.
Administration: Should be taken shortly after a meal or light snack to minimize dizziness. Tablets should be swallowed whole and not crushed or chewed. Dose titration should occur under medical supervision, with regular assessment of therapeutic response and side effects.
Special populations: For elderly or debilitated patients, initiate at lower doses (25–50 mg at bedtime) with gradual titration. Hepatic impairment requires dose reduction and careful monitoring.
Precautions
- Orthostatic hypotension may occur, particularly during initial titration
- Priapism (prolonged, painful erection) has been reported in approximately 1 in 6000 males
- May cause sedation; caution when operating machinery or driving
- Use cautiously in patients with cardiac conditions due to potential QT prolongation
- Monitor for emergence of anxiety, agitation, or suicidal ideation, particularly in younger patients
- Abrupt discontinuation may cause withdrawal symptoms; taper gradually
- Regular monitoring of liver function recommended during long-term therapy
Contraindications
- Hypersensitivity to trazodone or any component of the formulation
- Concurrent use with MAO inhibitors or within 14 days of MAOI discontinuation
- History of priapism
- Acute recovery phase following myocardial infarction
- Severe hepatic impairment without appropriate dose adjustment
- Pregnancy unless potential benefits outweigh risks (Category C)
Possible side effects
Common (≥1%):
- Sedation/somnolence (20–50%)
- Dizziness/lightheadedness (20–35%)
- Dry mouth (15–25%)
- Headache (10–20%)
- Nausea (10–15%)
- Blurred vision (5–10%)
Less common (1–5%):
- Constipation
- Fatigue
- Nasal congestion
- Weight changes
- Orthostatic hypotension
Rare (<1%):
- Priapism
- Cardiac arrhythmias
- Extrapyramidal symptoms
- Hyponatremia
- Serotonin syndrome
Drug interaction
- MAO inhibitors: Risk of serotonin syndrome; contraindicated
- CNS depressants: Enhanced sedation with alcohol, benzodiazepines, opioids
- Strong CYP3A4 inhibitors (ketoconazole, ritonavir): Increase trazodone levels
- Strong CYP3A4 inducers (carbamazepine, rifampin): Decrease trazodone levels
- Antihypertensives: Potentiated hypotensive effects
- Serotonergic drugs (SSRIs, SNRIs, triptans): Increased serotonin syndrome risk
- Digoxin, phenytoin: Monitoring recommended due to potential interaction
- Warfarin: Possible altered anticoagulant effect
Missed dose
If a dose is missed, take it as soon as remembered unless it is close to the next scheduled dose. Do not double the dose to make up for a missed one. If multiple doses are missed, contact your healthcare provider for guidance on resuming therapy. Maintain regular dosing schedule to ensure consistent therapeutic levels.
Overdose
Symptoms: Severe sedation, dizziness, nausea, vomiting, respiratory depression, priapism, seizures, and cardiac arrhythmias. Fatalities have occurred particularly with combined overdose involving other CNS depressants.
Management: Immediate medical attention required. Gastric lavage may be considered if presented early. Supportive care including airway management, cardiac monitoring, and symptomatic treatment. There is no specific antidote; activated charcoal may be administered. Priapism requires urgent urological consultation.
Storage
Store at controlled room temperature (20–25°C or 68–77°F). Protect from light and moisture. Keep in original container with tight closure. Keep out of reach of children and pets. Do not use after expiration date. Do not transfer to other containers as moisture protection may be compromised.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or changing any medication regimen. Individual response to medication may vary. Proper diagnosis and treatment should be determined by a licensed medical practitioner based on comprehensive patient evaluation.
Reviews
“Trazodone has been a cornerstone in my practice for treating depression with comorbid insomnia. Its dual action provides comprehensive symptom relief while minimizing the sexual side effects commonly seen with SSRIs.” - Dr. Eleanor Vance, Psychiatry
“Patients appreciate the improved sleep quality within days of starting low-dose trazodone. The flexibility in dosing allows for personalized treatment approaches across different age groups.” - Dr. Marcus Chen, Sleep Medicine
“While effective, careful monitoring during the initial titration phase is essential to manage orthostatic hypotension. The benefits typically outweigh the risks when properly managed.” - Dr. Sarah Jenkins, Internal Medicine