Trazodone (Desyrel)

What it treats

Trazodone is approved by the U.S. Food and Drug Administration to treat major depressive disorder. In everyday practice, though, its most common use is different. Prescribers most often use it at low doses for insomnia. That is an off-label use, meaning a purpose the label doesn't formally list even though evidence and practice support it.

It is worth being clear about this gap. Trazodone's formal approval is for depression, but its most common real-world use is as a sleep aid. The dose tells you which job it is doing.

How it works

Trazodone affects serotonin, one of the brain's chemical messengers, and it blocks certain receptors. That receptor blocking is what makes it sedating.

The dose changes what trazodone is doing. At the low doses used for sleep, the sedating effect is the point. At the higher doses used for depression, it acts as an antidepressant. As with other antidepressants, the full mechanism isn't fully understood, and the antidepressant effect is thought to come from slower changes in the brain over weeks rather than from the first dose.

What to expect

Common side effects

Most people get some side effects. The common ones include:

• Drowsiness and sedation.
• Dizziness.
• Dry mouth.
• Headache.
• Blurred vision.
• Morning grogginess, if the dose is higher than that person needs.

Morning grogginess is often a sign the dose can be lowered, so it is worth raising with the prescriber. If a side effect is severe, or it isn't improving, that's a conversation to have with the prescriber rather than a reason to stop on your own.

Serious side effects and warnings

Serious problems are uncommon, but a few are worth knowing.

Boxed warning. Like all antidepressants, trazodone carries an FDA boxed warning that it can increase suicidal thoughts and behaviors in children, teenagers, and young adults under 25, especially in the first weeks of treatment or after a dose change. This does not mean the medication harms most people. It means the early period deserves close attention, and that any worsening of mood, agitation, or new thoughts of self-harm should prompt contact with the prescriber promptly.

• Priapism. Rare but important, this is a prolonged and painful erection that does not go away. It is a medical emergency and needs immediate care, because lasting damage can result if it is not treated quickly.
• A drop in blood pressure on standing. Trazodone can lower blood pressure when a person stands up, which can cause dizziness or falls. This matters most for older adults.
• Serotonin syndrome. A rare reaction caused by too much serotonin activity, most likely when trazodone is combined with other drugs that raise serotonin. Signs include agitation, a fast heartbeat, high body temperature, shivering, muscle twitching, and confusion. It is a medical emergency.
• Effects on heart rhythm. At higher doses, trazodone can affect the heart's rhythm, which a prescriber may consider for some people.

Sexual side effects

Trazodone does not typically cause the reduced sex drive and delayed orgasm seen with SSRIs. For people who want to avoid those effects, that is often a point in its favor.

The sexual side effect that matters with trazodone is priapism, the rare but serious prolonged erection described above. It is uncommon, but because it is a medical emergency, it is worth knowing about before starting the medication.

Weight, appetite, and sleep

Trazodone is relatively weight-neutral, which sets it apart from some other antidepressants. Its main use is for sleep. It is sedating and is taken at bedtime, where the drowsiness works in your favor.

Starting and dosing basics

This section is general background, not a dosing instruction for any individual. The right dose is a decision for a prescriber.

Trazodone comes as tablets. The dose depends on the purpose. For sleep, low doses are used. For depression, much higher doses are needed. The prescriber sets the dose for the job it is meant to do and adjusts it based on how a person responds and tolerates it.

Missed doses and interactions

If you miss a dose, the general guidance is to take it when you remember, unless it is almost time for the next dose. In that case, skip the missed dose and carry on. Don't take two doses to make up for one.

A few interactions matter. Trazodone must not be combined with MAOI antidepressants, and a gap is needed when switching between them. Alcohol and other sedating drugs add to drowsiness and should be approached with care. Combining trazodone with other drugs that raise serotonin increases the risk of serotonin syndrome. Give every prescriber and pharmacist a full list of your medications and supplements, including over-the-counter ones.

Stopping and tapering

One point in trazodone's favor as a sleep aid is that it is not a controlled substance. It does not cause the dependence seen with benzodiazepines or z-drugs, the common prescription sleeping pills.

Low-dose use for sleep is generally straightforward to stop. Longer-term or higher-dose use is best tapered with a prescriber, stepping the dose down over time, because the body does adjust to it. Deciding to stop because you feel better is understandable, but it is still worth doing with guidance.

Pregnancy and breastfeeding

This is an area where individual circumstances matter and the decision belongs with a clinician. Untreated depression and poor sleep carry their own risks during pregnancy, and trazodone also passes into breast milk in small amounts. None of that adds up to one answer that fits everyone. Anyone who is pregnant, planning a pregnancy, or breastfeeding should talk it through with their prescriber so the specific risks and benefits can be weighed for their situation.

Cost and generic availability

Trazodone has been available as a generic for many years and is inexpensive. Generic trazodone contains the same active medication as the brand name and works the same way. Most insurance plans cover it, and for people paying out of pocket, it is among the lower-cost options for both depression and sleep.

Common questions

Why is an antidepressant used for sleep? Trazodone is sedating because of the way it blocks certain receptors. At low doses, that sedating effect is useful for sleep, even though the medication's formal approval is for depression.

Is trazodone addictive? No. It is not a controlled substance and does not cause the dependence or cravings seen with benzodiazepines or z-drugs. The body does adjust to it, so longer-term use is best tapered.

Will I feel groggy in the morning? Some people do, especially if the dose is higher than they need. Morning grogginess is often a sign the dose can be lowered, so it is worth telling the prescriber.

How is it different from a sleeping pill like a benzodiazepine? Trazodone is not a controlled substance and does not carry the dependence risk that benzodiazepines and z-drugs do. That is a key reason it is often chosen for longer-term sleep problems.

How fast does it work for sleep? At the low doses used for sleep, trazodone works the same night.

Questions to ask your prescriber

• Am I taking this for sleep, for depression, or both, and what dose fits that purpose?
• Which side effects should I expect, and which ones should I call about?
• How long should I plan to take it?
• If I feel groggy in the morning, what should we adjust?
• If we decide to stop it later, how would we do that safely?

Sources

This guide draws on current prescribing information and public health references. It is reviewed for clinical accuracy and updated as guidance changes.

• U.S. Food and Drug Administration. Trazodone hydrochloride (Desyrel) prescribing information.
• MedlinePlus, U.S. National Library of Medicine. Trazodone.
• National Institute of Mental Health. Mental health medications.