What is Trazodone and What is it Used For?

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Depression is a major mental health issue in the United States, affecting a sizeable portion of both the adult and juvenile populations.

According to the National Institute for Mental Health, it is estimated that 17.3 million American adults, or about 7.1 percent of the population, suffered from a major depressive episode in 2017.

While there are many different ways to treat depression, including lifestyle modifications and talk therapy, many people who suffer from major depressive disorder need the assistance of medications like trazodone to find adequate relief from their symptoms.

Trazodone is the generic form of a medication called Desyrel, but what is trazodone, and what is it used for? 

What is Trazodone?

Trazodone is the generic form of Desyrel and belongs to a class of medications called atypical antidepressants.

Atypical antidepressants like trazodone are used to treat a variety of mental health conditions, including depression and anxiety.

Trazodone was approved by the U.S. Food and Drug Administration (FDA) under the brand name Desyrel in 1981, which means that its use and effects have been studied extensively since it has been in use for nearly 40 years.

What is Trazodone Used to Treat?

Trazodone is primarily used for the treatment of clinical depression, also known as major depressive disorder. It is also used for the treatment of anxiety and is sometimes prescribed for insomnia off-label. 

Clinical Depression/Major Depressive Disorder

There are numerous types of depression, but when depression is experienced for an extended period of time, it is called clinical depression, also known as major depressive disorder or major depression.

Major depressive disorder is characterized by feelings of intense and persistent sadness that last for a minimum of two weeks, but the symptoms often last for much longer. 

Mental symptoms of clinical depression include things like a loss of interest in hobbies that were previously enjoyed, feelings of worthlessness, sadness, and hopelessness, but there are also physical symptoms associated with depression.

Commonly, patients with clinical depression may experience changes to their eating and sleeping patterns. People with major depressive disorder can also experience suicidal thoughts or behaviors

Symptoms of major depressive disorder include:

  • Feelings of moving or thinking in slow motion
  • Sleeping and eating more or less than usual
  • Feelings of worthlessness, guilt, hopelessness, or helplessness
  • Feeling sad, empty, or tearful
  • Difficulty concentrating and low energy
  • Lost of interest in activities you used to enjoy
  • Nervous energy
  • Suicidal thoughts or behaviors

Anxiety

The most common type of anxiety is generalized anxiety disorder (GAD).

While the vast majority of people will experience feelings of anxiety at some point in their lives in different situations, anxiety becomes a mental health problem when the feelings become extreme, interfere with a person's quality of life, or last for more than six months.

Anxiety is the natural response to the body during times of stress, and it is characterized as apprehension or fear about the future.

People with GAD find that they have chronic anxiety that is generally not provoked by any specific situation or fear.

Symptoms of generalized anxiety disorder include:

  • Panic attacks (which when recurring, might indicate a panic disorder)
  • Difficulty falling asleep 
  • Restlessness 
  • An increased heart rate
  • Rapid breathing
  • Trouble concentrating

Is Trazodone Used for Sleep?

Although trazodone was initially designed to treat depression and anxiety, it is commonly prescribed today as a sleeping pill for people with trouble sleeping.

Trazodone is a popular choice as a sleep aid because it provides a sedative effect for many patients, creating feelings of sleepiness and relaxation. Unlike other prescription insomnia medications, including Ambien and Lunesta, trazodone is not a controlled substance, and the potential for misuse and abuse of the prescription drug is much lower.

Trazodone is a generic drug that is highly accessible and affordable, and unlike controlled substances, your doctor is not limited in the number of pills that can be prescribed.

People who take trazodone for sleep typically begin to feel the effects of the medication in about 30 minutes. 

How Does Trazodone Work?

Trazodone is an atypical antidepressant, which means it works differently than antidepressants belonging to other classes, including Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), and tricyclic antidepressants.

Trazodone works by increasing the number of natural neurotransmitters in the central nervous system, including serotonin.

This action helps to restore depleted chemicals in the brain. Serotonin plays a major role in regulating the body's sleep cycle in addition to mood, digestion, appetite, memory, desire, and sexual function.

Although researchers have yet to pinpoint the exact cause of depression, trazodone is able to treat the condition by inhibiting the uptake of serotonin by certain nerves and stimulating other nerves.

How Do I Know What Dose of Trazodone to Take?

Your health care professional will help determine the right dose of trazodone for you based on your age and the medical condition being treated with trazodone.

It sometimes takes trying several different dosages before finding the right dose of trazodone for you. Trazodone is available in 50 mg, 100 mg, 150 mg, and 300 mg strengths.

Adults suffering from major depressive disorder typically receive an initial dose of 150 mg per day taken in divided doses, with an outpatient daily maximum dosage of 400 mg per day.

Other times, patients may be put on low doses to start. When used on an inpatient basis, patients may receive up to 600 mg per day. The effects of Trazodone are normally experienced in about four weeks.

If the dose of trazodone is changed or if there's abrupt discontinuation, patients can experience withdrawal symptoms, particularly if they have been taking the medication for six weeks or more.

Patients should not change their dose of trazodone or stop using the medication without advice from their healthcare provider. Symptoms of withdrawal include:

  • Dizziness
  • Agitation
  • Confusion
  • Tingling
  • Vomiting
  • Sweating
  • Numbness
  • Feelings of electric shock

What are the Side Effects of Trazodone?

The most common side effects associated with trazodone are generally mild, but some people may experience more serious side effects. Side effects associated with trazodone include:

  • Blurred vision
  • Drowsiness
  • Fatigue
  • Nausea
  • Vomiting
  • Swelling
  • Disorientation
  • Nasal congestion
  • Fainting
  • Weight change
  • Decreased libido
  • Sedation
  • Anxiety
  • Anemia
  • Double vision
  • Urinary retention
  • Dizziness
  • Dry mouth
  • Headache
  • Constipation
  • Confusion
  • Lack of coordination
  • Feeling faint or dizzy when standing
  • Lightheadedness
  • Tremors
  • Ejaculation disorder
  • Painful erection
  • Hair loss
  • Acne
  • Increased appetite
  • Insomnia
  • Vertigo

Are Any Drug Interactions Associated with Trazodone?

There are numerous drug interactions associated with trazodone, most of which are moderate to mild. However, some medications can cause severe interactions when taken with trazodone. These medications include, but are not limited to:

  • Arsenic trioxide
  • Cisapride
  • Eliglustat
  • Indapamide
  • Pentamidine
  • Pimozide
  • Saquinavir
  • Terfenadine
  • Astemizole
  • Disopyramide
  • Ibutilide
  • Isocarboxazid
  • Phenelzine
  • Procainamide
  • Sotalol
  • Tranylcypromine
  • Phenytoin

What Risks are Associated with Trazodone?

Regardless of whether you take trazodone to treat depression, anxiety, insomnia, or another condition, there are risks of adverse effects associated with use of the medication.

The FDA lists the following risks associated with trazodone, and you should seek medical advice or medical attention if these symptoms become apparent:

  • Thoughts of suicide, especially in young adults and children
  • Serotonin syndrome, a dangerous condition in which too much serotonin builds up in the body, leading to potentially serious reactions. Taking antidepressant medications like fluoxetine while also taking trazodone can increase this risk. Symptoms of serotonin syndrome include:
    • Hallucinations
    • Dizziness
    • Agitation
    • Seizures
    • Increased heart rate
    • Headaches
    • Increased body temperature
    • Muscle tremor
    • Trouble with balance
    • Rigidity
    • Nausea
    • Diarrhea
    • Vomiting
  • Cardiac arrhythmia, particularly in people who already have heart problems
  • Priapism
  • Hypotension, or sudden low blood pressure when moving from sitting to standing
  • Increased risk of bleeding, particularly in patients taking blood thinners
  • Mania
  • Blurred vision
  • Hyponatremia, a dangerous sodium imbalance that can cause the following symptoms:
    • Headache
    • Weakness
    • Seizures
    • Confusion
    • Unsteadiness

Who Should Not Take Trazodone?

People who take certain types of drugs known to cause dangerous interactions with trazodone, including monoamine oxidase inhibitors (MAO inhibitors/MAOIs) such as isocarboxazid, methylene blue injection, phenelzine, selegiline, linezolid, rasagiline, and tranylcypromine, and people taking blood thinners should not take trazodone.

People who are allergic to trazodone of nefazodone should not take the medication.

Some other groups of people should also use caution when taking trazodone.

Be sure to give your doctor a complete medical history, especially including any personal or family history examples of:

  • Allergic reactions to any drugs or supplements
  • Liver or kidney disease
  • Bleeding or blood clotting disorder
  • Narrow-angle glaucoma
  • Drug addiction
  • Suicidal thoughts
  • Bipolar disorder
  • Heart disease or recent heart attack
  • Seizures or epilepsy
  • Long QT syndrome

Older adults are more likely to experience side effects when taking trazodone, particularly bleeding and loss of coordination.

Loss of coordination can lead to an increased risk of falling, which can be serious and even fatal for the elderly. Older adults are also at increased risk of developing low blood sodium. 

References:

https://www.nimh.nih.gov/health/statistics/major-depression.shtml 

https://www.healthline.com/health/depression/effects-brain 

https://www.hazeldenbettyford.org/articles/trazodone 

https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018207s032lbl.pdf 

https://www.drugs.com/trazodone.html 

https://www.webmd.com/drugs/2/drug-11188/trazodone-oral/details

https://www.healthline.com/health/sleep/trazodone-for-sleep#risks 

https://www.rxlist.com/trazodone/drugs-condition.htm 

https://www.drugs.com/dosage/trazodone.html

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