Trazodone, also marketed as Desyrel, Beneficat, Deprax, Oleptro, and other brand names, is an atypical antidepressant with FDA approval for the treatment of depression and sleep disorders (primarily insomnia but also disturbances such as night terrors and nightmares). This medication is chemically similar to the other better known atypical antidepressants such as Prozac and Zoloft [serotonin-specific reuptake inhibitors (SSRIs)] but it works on many different receptors as an agonist and not a reuptake inhibitor
What is Trazodone prescribed for?
Most commonly, Trazodone is prescribed when a patient struggling with depression or complains of insomnia. Although chemically an antidepressant, trazodone seems to be an effective sleep aid without the unwanted side effects associated with central nervous system (CNS) depressants (such as Valium, Librium, or Xanax). Trazodone is not a depressant at all, and the precise mechanism by which it promotes sleep/sedation is not well understood. However, it has gained FDA approval for use in major depressive disorder, bipolar disorder when the patient’s presentation is depressed, and insomnia.
Trazodone is prescribed for a number of other conditions, including anxiety and related disorders such as bulimia and obsessive compulsive disorder. Pain syndromes such as fibromyalgia may also be treated with trazodone, as this medication was originally synthesized based upon a theory of depression that proposed a link between depression and a lowered pain threshold.
What does it do?
Trazodone is a serotonin antagonist and reuptake inhibitor, meaning that it ensures that higher levels of serotonin remain available for circulation in the brain. However, trazodone acts on many different receptors in the brain, not exclusively serotonin receptors, and its specific mechanism of action both as an antidepressant and as a sleep aid are not known. It shares some similarities with the SSRIs, both in mechanism and in side effects, but it is not reported to be as effective as the other more commonly prescribed SSRIs against depressive symptoms, with the exception of insomnia.
What are the Most Common Side Effects?
Trazodone has fewer side effects than the tricyclic antidepressants, but side effects similar to those experienced by users of SSRIs are frequently reported.
- Headache or discomfort and “heaviness”
- Nausea, queasiness, and unpleasant taste
- Dry mouth
- Gastric distress: diarrhea and/or constipation
- Appetite changes
- Weight gain or loss
- Weakness, daytime fatigue
- Memory and/or concentration issues
- Mental fuzziness
- Vision changes, blurriness, and/or red eyes
Sexual side effects are also reported, although with less frequency than other SSRIs.
Trazodone is metabolized in the liver and shares its specific mechanism of metabolism with several other foods, drinks, and other substances. This means that many potential drug interactions may occur. One such substance that can interact with trazodone and cause problems with the proper metabolism and clearance of trazodone is grapefruit juice. It is recommended that grapefruit juice should not be consumed while taking this medication.
Trazodone is also a close enough chemical cousin to SSRIs to carry the black box warning regarding suicide, and to require a careful titration when discontinuing use.
Due to Trazodone’s effectiveness as a sleep aid, care should be taken regarding daytime use of this medication. Driving or operating machinery may be inadvisable, especially during the initial few weeks of becoming accustomed to the medication. For the same reason, any use of alcohol or CNS depressants while on Trazodone should be carefully monitored.