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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Depression isn’t just feeling sad or down. This mood disorder can affect all aspects of life, including your appetite, weight, sleep, work, and relationships (NIMH, 2018).
Although we don’t yet know exactly how depression works, we do know it has to do with the balance of certain chemicals in the brain (Chand, 2020). Prescription medications like trazodone may help by affecting the levels of these chemicals. Still, you may worry about the potential side effects of these prescription drugs. If you’re talking to your healthcare provider about trazodone, here’s what you need to know.
What are the side effects of trazodone?
The most common side effects of trazodone are drowsiness, nausea, dizziness, and dry mouth (Zhang, 2014). Trazodone is generally well tolerated and may be less likely than some other antidepressants to cause insomnia, sexual side effects, and anxiety (Shin, 2020).
Clinical trials have also reported other side effects, including blurry vision, constipation, confusion, fatigue, nervousness, tremors, and weight changes (FDA, 2017).
You may be more likely to experience side effects if you’re taking certain medications with trazodone. For example, there are drugs that can impact a system in your liver called CYP3A4, which breaks down trazodone (Shin, 2020). These medications may slow down this system, resulting in a buildup of trazodone in your body. In other words: increased levels of trazodone means an increased risk of potential side effects (NIH, 2017).
Serious side effects of trazodone
While not as common, trazodone does have the potential for serious side effects.
The drug can cause serotonin levels in the body to become too high, leading to a condition called serotonin syndrome. Normally, chemical messengers (also known as neurotransmitters) pass messages between cells in the brain. Serotonin is one type of neurotransmitter. Researchers suggest medications like trazodone help alleviate depression by maintaining high levels of serotonin in the brain.
However, abnormally high serotonin levels can cause adverse effects ranging from mild to life-threatening (Volpi-Abadie, 2013). Symptoms of serotonin syndrome include agitation, anxiety, disorientation, flushed skin, increased heart rate, nausea, restlessness, sweating, tremor, and vomiting. Shaking is particularly common (Simon, 2020). Trazodone may also cause fainting, irregular heartbeat, chest pain, seizures, shortness of breath, or difficulty breathing (NIH, 2017). Contact a healthcare provider immediately if you experience any of these symptoms.
Because the side effects of trazodone are dose-dependent, you have a higher chance of experiencing adverse effects with higher doses (Jaffer, 2017). Communicate with your healthcare provider about how you’re feeling so they can find the right dose for you. A healthcare provider can work with you to find the lowest amount that effectively manages your depression to minimize the side effects you experience.
Serotonin syndrome: symptoms, causes, treatment
What is trazodone?
Trazodone is a generic medication (also sold under the brand names Desyrel and Oleptro; see Important Safety Information) approved by the FDA to treat major depressive disorder (MDD) (FDA, 2017). Trazodone works by increasing the levels of available serotonin in the brain, which helps alleviate depression symptoms (NIH, 2017).
Trazodone is also used off-label (in a way not specifically approved by the FDA) to treat insomnia, especially in people with depression. Chronic insomnia is different from regular sleep problems that we all experience from time to time. This condition can cause problems sleeping for a month or more. If you’re experiencing this kind of insomnia, you may be prescribed trazodone to help get your sleep schedule back on track. Trazodone is also used off-label for agitation in people with dementia.
Trazodone carries a black box warning from the U.S. Food and Drug Administration, which states the following (FDA, 2017): certain antidepressants, including trazodone, have an increased risk of suicidal thoughts and behaviors, especially children, teenagers, and young adults. Families and caregivers should be aware of this risk, especially during the first few months of therapy or after a dose increase. They should also be on the lookout for suicidal thoughts, attempts, or completions, or other mood changes. Trazodone is not FDA-approved for use in people under 18 years of age.
Patients taking trazodone who have been diagnosed with MDD may be at risk of attempting suicide or self-harm (Coupland, 2014). A healthcare provider can work with you and your family to monitor the severity of your depression symptoms—especially when first starting the medication, or after a change in dosage.
Trazodone tends to cause less anxiety and insomnia and fewer sexual side effects than some other SSRIs and SNRIs, but that doesn’t mean it’s without side effects (Shin, 2020). The drug may also cause anxiety, agitation, panic attacks, difficulty sleeping, irritability, hostility, impulsivity, and movement disorders. If you experience any of these, tell a healthcare provider who can stop or change your medication. This is also the reason trazodone should not be prescribed for anyone with a history of bipolar disorder.
If you suddenly stop taking trazodone, you may experience what’s called discontinuation syndrome (NIH, 2017). This is when patients who have been on an antidepressant for at least six weeks experience side effects from abruptly stopping treatment. About one in five people get discontinuation syndrome, which symptoms may include balance problems, feeling like you have the flu, nausea, and trouble sleeping. These symptoms may take up to two weeks to go away (Warner, 2006). If you wish to discontinue trazodone, work with a healthcare professional to do it gradually and safely.
Trazodone: warnings, side effects, and more
Trazodone should not be taken with other medications or over-the-counter supplements that increase serotonin levels. Here are the main ones to avoid (NIH, 2017):
- Tricyclic antidepressants
- Selective serotonin reuptake inhibitors (SSRIs)
- St. John’s wort
Be careful taking trazodone with any blood thinners. If you need to take blood thinners while on trazodone, a healthcare provider may adjust your dose to limit bleeding risk (NIH, 2017).
Talk to a healthcare provider if you wish to drink alcohol while taking trazodone. Alcohol slows down the central nervous system, which may slow your reaction time and trazodone can enhance these effects (NIH, 2017).
Treatment for major depressive disorder with trazodone is generally well-tolerated, but there are side effects. The most common ones are dry mouth, drowsiness, dizziness, and nausea, but more serious side effects are possible. Make sure your healthcare provider knows what other medications you’re on so they can determine whether trazodone may be a good option for you.
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Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.