SUBSTANCE ABUSE
Trazodone
Trazodone is a prescription antidepressant medication that balances chemicals in the brain in people who have depression. Trazodone helps to restore the balance of serotonin (a natural chemical) in the brain. People who have depression are believed not to have enough serotonin in the brain. Serotonin influences mood, emotion, and sleep, so it is very important for serotonin levels in the brain to be balanced.
Trazodone helps to improve mood, appetite, and energy levels, therefore combatting anxiety and depression. While many people are familiar with antidepressants such as Prozac that are SSRIs (selective serotonin reuptake inhibitor), trazodone is a SARI, which stands for serotonin antagonist and reuptake inhibitor. While SSRIs are more widely known and used, trazodone is typically prescribed when other antidepressants don’t work or have too many negative side effects.
What is Trazodone Used For?
Trazodone is approved by the Federal Drug Administration (FDA) for use in treating depression. However, due to its sedating effects, it is often also used to treat insomnia, anxiety, fibromyalgia, Alzheimer’s disease, and other conditions/disorders. More and more frequently, trazodone is being prescribed off-label for the treatment of anxiety and insomnia.
Medications are considered off-label when they’re prescribed for something that the FDA has not approved them for. The main reason that a doctor may prescribe you something off-label is that no other medication has been effective, so the doctor might prescribe something that is known to work, but doesn’t have FDA approval for that particular purpose. This is perfectly normal and for many people, the pre-approved medications used for depression and anxiety might not work or might have too many negative side effects.
Another use of trazodone is for addiction treatment. Because trazodone can help you sleep, it can be useful during the treatment process of drug addiction.
Trazodone in Addiction Treatment
Trazodone is sometimes used as a part of a treatment plan for someone recovering from addiction. It can be used for people seeking help with alcohol addiction and methamphetamine abuse. It can help improve sleep in people with alcohol disorder and can help improve sleep in people undergoing methadone maintenance treatment. Because many people with drug addictions also struggle with feelings of depression or anxiety, trazodone can help to alleviate some of those symptoms during the process of addiction treatment.
Brief History of Trazodone
Trazodone was developed in Italy in the 1960s as a potential antidepressant. While it was effective, it also had a number of negative side effects that made it unpopular. Due to its sedative properties, some people were fainting when they would stand up quickly. It also caused priapism, which is a condition involving uncontrolled and painful penile erections that sometimes required surgery. Once other more popular antidepressants hit the market (e.g. Prozac), trazodone was not prescribed as often anymore. In 1982 however, it was approved by the FDA for the treatment of depression and is now often used as an alternative for people who do not respond well to other antidepressants.
Other Names
Brand Names
Desyrel
Desyrel Dividose
Oleptro
Slang Name
Sleepeasy
TRAZODONE SIDE EFFECTS
You should also report any new or worsening symptoms to your doctor. If your mood or behaviour changes, if you feel an increase in anxiety, have panic attacks, have trouble sleeping, feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive, more depressed, or have suicidal thoughts, tell your doctor. This allows your doctor to adjust your dosage correctly or you may be switched to a different medication.
Not all anti-depressant medications work for everyone, and it can take a process of trial and error to find the right fit. Just because your doctor prescribes you a medication does not mean that it is guaranteed to work for you. Everyone is different and responds differently to various medications.
As with all medications, there are potential side effects that can occur. Some side effects that you might experience are:
- Constipation
- Dry, itchy or red eyes
- Fatigue
- Memory problems
- Trouble sleeping
- Numbness
- Chest pain
- Erectile dysfunction
- Headache
- Overdose
- Priapism (painful and prolonged penile erection)
- Sedation
- Sweating
- Withdrawal
- Diarrhea
- Dry mouth
- Muscle pains
- Nausea
- Blurred vision
- Confusion
- Difficulty breathing
- Fainting
- Light-headedness
- Panic attack
- Ringing in the ears
- Seizure
- Weight gain
Some serious but rare side effects that may be a potential risk when taking trazodone are:
Increase in suicidal thoughts and behaviors, specifically in children and young adults
Priapism
Cardiac arrhythmias (faster/slower than normal heartbeats or irregular heartbeats)
Anaphylaxis (severe allergic reaction)
If you experience any severe side effects, seek emergency medical help or contact your doctor immediately.
Serotonin Syndrome
Another serious potential risk of trazodone is serotonin syndrome. Serotonin syndrome occurs when there is too much serotonin in the brain and therefore, excessive nerve cell activity.
If you experience any of the following symptoms of serotonin syndrome, seek medical help immediately:
Agitation
Diarrhea
Fast heart rate
Fever
Hallucinations
Loss of coordination
Muscle stiffness
Sweating/shivering/twitching
Nausea
Vomiting
HOW EFFECTIVE IS TRAZODONE?
Although there is limited research regarding the effectiveness of trazodone, a group of doctors and academic professionals conducted a study in 2017 where they looked at data from a period of 33 years (1983-2016). One of the points of the research was to investigate the effectiveness of trazodone for insomnia. Interestingly, trazodone is prescribed off-label more often for insomnia than it is prescribed for the treatment of depression. Results of the study showed that trazodone is repeatedly found to be effective in the treatment of insomnia, as well as to help with symptoms of depression.
How to Take Trazodone Safely
It is important to follow your doctor’s instructions for how to take trazodone and to also read the medication guide. You should take the medication as prescribed and not increase the dose or take it more often than prescribed.
A Note on Safely Taking Medications
Taking more trazodone than prescribed will not help improve your symptoms any faster. It is also important to not stop taking this medication without consulting your doctor. There can be negative effects (anxiety, agitation, trouble sleeping) to stopping an anti-depressant medication suddenly.
Understanding Dosages and Administration
Trazodone is typically taken orally, by swallowing a pill once or twice daily after a meal or snack, or as directed by your doctor. Tablets come in immediate-release and extended-release form. Common dosages include 50 mg, 100 mg, 150 mg and 200 mg tablets.
Due to the drowsiness that can be caused by trazodone, it is usually best to take it at bedtime. As with all anti-depressant medications, it takes between 2 to 4 weeks to begin noticing the effects of the medication and before beginning to feel better.
It is possible, especially for young adults, to feel an increase in suicidal thoughts when first beginning to take this medication. For this reason, doctors are often hesitant to prescribe trazodone to teenagers or young adults. This should subside over time but you should communicate how you are feeling to your doctor so that they can monitor your symptoms.
Precautions
If you are allergic to trazodone or are being treated with methylene blue injection, then you should not be taking trazodone. You shouldn’t use this medication if you have taken an MAO inhibitor (a strong anti-depressant) in the past 14 days. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine that can interact dangerously with trazodone. If you stop taking trazodone, you should wait at least 14 days before taking an MAO inhibitor.
Before using trazodone, you should tell your doctor about your personal and family medical history, particularly if there is a history of bipolar disorder, depression, heart disease, liver disease, kidney disease, blood pressure issues, or glaucoma.
When to Avoid Trazodone
To ensure that trazodone is safe for you, tell your doctor if you have ever had:
•Liver/kidney disease
•Heart disease
•Recent heart attack
•Blood clotting disorder
•Seizures/epilepsy
•Glaucoma (an eye condition)
•Long QT syndrome (a heart rhythm condition)
•Drug addiction
•Suicidal thoughts
•Bipolar disorder
You should also ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam or others. Using these types of pain killers with trazodone can put you at higher risk of bruising or bleeding easily.
Trazodone is not approved for use by anyone under 18. It also may not be safe to use while breastfeeding, so talk to your doctor before using trazodone if you are pregnant or breastfeeding. You should also avoid alcohol while taking trazodone.
Interaction With Other Drugs
Taking multiple drugs or medications at the same time can impact how each of those drugs work. It is important to tell your doctor what medications you are taking prior to being prescribed anything else. Some of the drugs that have interactions with trazodone that you should inform your doctor(s) about are:
Phenytoin (an anti-epilepsy drug)
St. John’s wort (used for depression)
Tramadol (pain medication)
A diuretic (used to help urination)
Medicines used to treat anxiety, mood disorders, or mental illness (e.g. fluoxetine, paroxetine, duloxetine, venlafaxine)
Blood thinners (e.g. warfarin, Coumadin, Jantoven)
Migraine headache medication (e.g. Sumatriptan, Imitrex, Maxalt, Treximet)
You should also inform your doctor of any illicit drugs you are taking, as mixing trazodone with certain drugs such as ecstasy can increase the chance of having a negative reaction (e.g. overdose). You should also inform your doctor of anything you are taking that causes drowsiness such as alcohol, marijuana, allergy medications, medications for sleep or anxiety, muscle relaxants, or narcotic pain relievers. This is because trazodone has sedative properties that on its own can make you very tired.
Can You Overdose on Trazodone?
Although it is uncommon, you can overdose on trazodone. It is possible to take too much trazodone and therefore it must be taken with caution and according to direction.
Symptoms of trazodone overdose include:
•Extreme drowsiness
•Vomiting
•Dizziness or fainting
•Confusion
•Pounding heartbeat
•Problems breathing
vSeizures
•Priapism
If you or someone you know is experiencing symptoms of overdose, seek emergency medical help immediately.
How Often is Trazodone Prescribed?
The number of trazodone prescriptions in the U.S. have increased over the last 15 years:
These numbers are now fairly similar to the rates of prescription of other anti-depressants. However, trazodone is now prescribed more frequently for insomnia than it is for depression.
Can Trazodone be Abused?
While trazodone is not typically thought to be addictive and isn’t habit forming, in theory, almost any drug can be abused. Like the old saying goes, too much of anything isn’t good. Typically, however, antidepressants are abused in conjunction with other drugs. In other words, people who are abusing trazodone are typically abusing other drugs (such as ecstasy) as well.
Trazodone by itself is not typically someone’s primary drug of abuse. For people who do abuse trazodone, the pill is typically crushed to be inhaled, added to marijuana and smoked, added to an alcoholic drink, or snorted. Destroying the pill form increases the effects of trazodone and results in quicker effects. Because of trazodone’s sedative effects, some people will abuse it in order to feel a calming and relaxing effect.
Signs of Trazodone Abuse
•Taking trazodone without having a prescription
•Using more than prescribed, more often than prescribed
•Not using as prescribed (e.g. snorting it)
•Using together with other drugs such as alcohol, painkillers, marijuana, etc.
•Attempting to access more than prescribed by purchasing it illegally or stealing it
•Spending more and more time trying to get trazodone
•Continued use despite negative consequences
•Not keeping up with work, school, and home responsibilities
•Health issues as a result of drug use
•Using for purposes other than prescribed (e.g. to feel high or to enhance other drugs)
•Increased tolerance towards the drug
•Experiencing withdrawal symptoms
Trazodone Withdrawal Symptoms
When using large amounts of trazodone for long periods of time, stopping suddenly can cause withdrawal symptoms. For people who abuse trazodone, withdrawal symptoms can be particularly severe. Using trazodone balances the brain’s chemicals, so the brain becomes used to the daily presence of trazodone to keep serotonin levels balanced. When trazodone use stops suddenly, those levels become unbalanced and withdrawal symptoms can occur.
•Agitation
•Depression
•Fatigue
•Increase in heart rate & palpitations
•Irritability
•Muscle pain
•Sensations of electrical jolts in the brain
•Stomach aches
•Suicidal thoughts
•Weakness
•Anxiety
•Dizziness & balance problems
•Headaches
•Insomnia
•Nausea
•Restlessness
•Severe disorientation
•Sweating
•Vomiting
•Weight loss
Factors that affect the severity and duration of withdrawal symptoms include:
•Duration of trazodone use
•Dosage size
•How quickly you stop using trazodone
•Lifestyle
•Genetics
•Use of other substances with trazodone
Trazodone withdrawal can last anywhere from a few weeks to a few months depending on each individual. Typically, withdrawal symptoms should subside within 2 to 12 weeks of stopping use. Overcoming withdrawal symptoms doesn’t mean someone who has abused trazodone is automatically recovered and treatment should still be sought out.
Withdrawal symptoms are worse when someone tries to quit “cold turkey,” so it is advisable to enroll in a medical detox program to safely and comfortably manage withdrawal symptoms.
Addiction Treatment
As those abusing trazodone are frequently also abusing other drugs, a treatment plan needs to consider all substances that someone might be abusing. Developing a treatment plan will include the following:
Medical Detox:
In order to avoid experiencing severe withdrawal symptoms, a medical detox is needed. This way, you can slowly taper off the medication.
Treatment For Co-occurring Disorders:
This includes other addictions or mental illnesses. Treatment can occur in intensive outpatient programs or residential inpatient programs.
Educational Programs:
Learn more about drug addictions and relapse prevention strategies.
Therapy and Counseling:
Various therapy programs that target the causes of drug abuse, developing coping skills, relapse prevention programs, and more. Therapy can be individual or in a group setting.
12- Step Meetings:
These meetings help to create a sense of community and contribute to the long-term aftercare treatment plan.
Sober Living Programs:
These programs provide safe group housing options for people recovering from addiction. The goal of sober living program homes is to help people transition from residential or outpatient care into independent living.
Resources
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842888/
- https://www.statista.com/statistics/782116/trazodone-hydrochloride-prescriptions-number-in-the-us/
- https://www.drugs.com/sfx/trazodone-side-effects.html
- https://www.healthline.com/health/mental-health/trazodone-for-anxiety
- https://drugabuse.com/trazodone/
- https://www.webmd.com/drugs/2/drug-11188-89/trazodone-oral/trazodone-oral/details