THIS MEDICATION AFFECTS SEROTONIN LIKE OTHER ANTIDEPRESSANTS, BUT HOW IT WORKS AND WHAT IT TREATS SET TRAZODONE APART IN KEY WAYS
Trazodone hydrochloride is a generic prescription antidepressant used to treat depression in adults. Although healthcare providers may also prescribe it off-label for conditions such as insomnia and anxiety, trazodone is not classified as a selective serotonin reuptake inhibitor (SSRI).
While both trazodone and SSRIs affect serotonin in the brain, they work through different mechanisms. Understanding this distinction can help clarify how trazodone works and why it may be used differently from other antidepressants and sleep medications.
Key Takeaways
- Trazodone is not an SSRI, although it affects serotonin and can increase its activity in the brain.
- Trazodone is FDA-approved for treating depression, but healthcare providers also commonly prescribe it off-label for insomnia.
- Because trazodone can affect people differently, it’s important to seek personalised medical advice from a healthcare professional familiar with your medical history, existing conditions, other medications, and symptoms.
Is trazodone actually an SSRI?
No. Trazodone is not classified as an SSRI. Instead, it belongs to a group of antidepressants called serotonin antagonist and reuptake inhibitors (SARIs). The confusion is understandable because trazodone, like SSRIs, affects serotonin levels in the brain. Pasted text
How does trazodone work?
Trazodone shares one mechanism with SSRIs by reducing the reuptake of serotonin after it has transmitted signals between brain cells. This leaves more serotonin available in the brain, which can help improve depressive symptoms.
However, trazodone has additional effects that set it apart from traditional SSRIs. It blocks certain serotonin receptors as well as alpha-1 receptors, which contributes to its antidepressant, anti-anxiety, and sedating effects, according to Heather Gosnell, MD. Pasted text
Oluwatosin Ajao, MD, compares trazodone to a control panel with multiple switches because of the different ways it acts in the brain. By allowing serotonin to remain available longer while influencing other receptors, the medication may help with mood, anxiety, and sleep. Pasted text
Because of these multiple effects, trazodone may be particularly useful for people dealing with both depression and insomnia, although it is generally considered a less potent antidepressant than SSRIs such as Prozac and Zoloft. Pasted text
The history of trazodone
Trazodone was developed in 1966 and received FDA approval as an antidepressant in 1981. Although it remains an approved treatment for depression, newer antidepressants are often preferred as standalone treatments because they may be more effective. Pasted text
Trazodone is also sometimes prescribed alongside other antidepressants, including SSRIs. In these cases, it may help address sleep difficulties associated with SSRIs and potentially reduce some sexual side effects. Pasted text
Today, one of its most common uses is insomnia, particularly among people who also have depression or anxiety. Although trazodone is not FDA-approved specifically for sleep disorders, some providers use it because it is generally well tolerated, inexpensive, and considered less likely to cause addiction than certain other sleep medications.
Common uses for trazodone
The FDA has approved trazodone for the treatment of major depressive disorder (MDD) in adults. Pasted text
Healthcare providers may also prescribe it off-label for:
- Insomnia
- Anxiety-related conditions, including generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder
- Post-traumatic stress disorder (PTSD)
- Agitation associated with dementia Pasted text
Trazodone for depression
Trazodone increases serotonin activity and can be an effective, generally well-tolerated option for depression. Unlike some antidepressants that can interfere with sleep, trazodone has calming and sleep-promoting effects, which may make it useful for people whose depression is accompanied by insomnia. Pasted text
For depression, treatment may begin at 25–50 mg two to three times per day, with healthcare professionals commonly increasing the dose to 50–100 mg two to three times daily after the patient adjusts to the medication.
Trazodone for insomnia
Trazodone is frequently prescribed off-label for short-term insomnia, including difficulty falling asleep or staying asleep. Its sedating properties are one reason providers may choose it for this purpose.
A systematic review found that low doses may be safe and effective for short-term insomnia. However, the American Academy of Sleep Medicine recommends against using trazodone for chronic insomnia. Pasted text
A typical starting dose for insomnia is 50–100 mg at bedtime, although the appropriate dose can vary depending on the individual’s response.
Trazodone for anxiety and PTSD
Trazodone may sometimes be prescribed off-label for anxiety, particularly when anxiety occurs alongside sleep problems. Older research has suggested potential benefits for anxiety, panic disorder, and PTSD.
However, trazodone is not considered a first-choice treatment for these conditions. The appropriate dosage should be determined by a healthcare provider and may sometimes follow dosing used for depression.
Trazodone for dementia-related agitation
In certain cases, healthcare providers may use trazodone off-label to manage agitation associated with dementia, sometimes referred to as “sundowning.” It is not FDA-approved for this purpose.
Research comparing trazodone with haloperidol found that each medication appeared more helpful for different types of behavioural symptoms, while both had similar effectiveness for overall agitation. Treatment decisions should therefore be made individually by caregivers and healthcare professionals. Pasted text
There is no FDA-approved trazodone dosage for dementia-related agitation, so the healthcare team determines and adjusts the dose based on the patient’s response and caregiver observations. Pasted text
Trazodone dosage guidelines
For major depressive disorder, the DailyMed prescribing information lists total daily doses ranging from 150–400 mg, taken in divided doses. Pasted text
The medication label recommends starting treatment at a lower dose and increasing it gradually. A typical starting point is 150 mg per day in divided doses, followed by 50 mg increases as needed, up to a maximum of 400 mg per day. Pasted text
Trazodone should be taken immediately after a meal or snack to support proper absorption. Tablets may be swallowed whole or split along their score line, but they should not be crushed or chewed. Pasted text
If treatment needs to end, trazodone should generally be tapered under medical supervision rather than stopped suddenly
Trazodone vs. other sleep aids and antidepressants
Although trazodone can be useful for depression and sleep problems, it isn’t necessarily the best option for everyone.
Trazodone vs. other sleep medications
Several FDA-approved medications are available for insomnia, including benzodiazepines, non-benzodiazepine sedatives, and certain antidepressants.
One study found trazodone to be similarly effective to doxepin, an FDA-approved medication for insomnia. However, Dr. Gosnell notes that trazodone’s effectiveness for insomnia can be less consistent than that of FDA-approved sleep medications. Pasted text
Some providers may still favour trazodone because it has a lower addiction risk, can address both sleep difficulties and depression, is generally tolerated well at low doses, and is inexpensive.
Trazodone vs. other antidepressants
Trazodone has been available longer than many newer antidepressants, and its safety and effectiveness are well established. Still, it may not be the ideal antidepressant for every patient. Pasted text
Compared with SSRIs, trazodone may be less effective for depression, according to Dr. Gosnell. However, it may have advantages involving sexual side effects, weight gain, and sleep disruption, which can be concerns with some SSRIs. Pasted text
Because trazodone can also promote sleep, some providers may consider it when insomnia is part of the patient’s symptoms. On the other hand, it may be a poor choice for people who are already prone to dizziness or daytime sleepiness. Pasted text
How to discuss trazodone with your healthcare provider
Whether trazodone is appropriate depends on your medical and psychiatric history, existing conditions, symptoms, and other medications. A healthcare provider who knows your complete history can help determine whether it is an appropriate treatment. Pasted text
Be prepared to discuss how often and how severely you experience symptoms such as low mood, irritability, anxiety, and sleep difficulties. It’s also useful to discuss how well you tolerate potential side effects. Pasted text
Common side effects may include:
- Dizziness
- Dry mouth
- Blurred vision
- Drowsiness
- Constipation
- Weight gain Pasted text
More serious potential effects include:
- Changes in heart rate
- Glaucoma
- Low blood pressure
- Sexual dysfunction, including priapism
- Urinary incontinence
- Suicidal thoughts Pasted text
Trazodone can also interact with other medications. Tell your healthcare provider if you take MAO inhibitors, other serotonin-affecting medications or antidepressants, certain opioids, St. John’s wort, blood thinners, or strong CYP3A4 inhibitors, among other medications. Pasted text
Being transparent about your medications, health conditions, and symptoms can help your provider determine the safest and most appropriate treatment for you. Pasted text
Source: SingleCare