Trazodone
Generic: trazodone hydrochloride · Brand: Desyrel® · Class: SARI
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How It Works
Trazodone is a serotonin antagonist and reuptake inhibitor (SARI). It has a dual mechanism — it blocks certain serotonin receptors while also inhibiting serotonin reuptake, and it strongly blocks histamine receptors causing significant sedation. At low doses (25–100 mg) it is almost exclusively used as a sleep aid due to its sedating properties. At higher doses (150–400 mg) it functions as an antidepressant. It has no abuse potential and does not cause dependence, making it a popular alternative to sleep medications like benzodiazepines.
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What It Treats
InsomniaMost common use — low doses are highly effective for sleep onset and maintenance
Major Depressive DisorderEffective at higher doses, though less commonly used as primary antidepressant today
Anxiety DisordersUsed off-label for GAD and PTSD, particularly when sleep disruption is present
Nightmares / PTSDHelps reduce nightmares and improve sleep architecture in PTSD
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Dosing Overview
| Population | Start | Typical Range | Max |
|---|---|---|---|
| Adults Insomnia | 25–50 mg at bedtime | 50–100 mg | 200 mg |
| Adults Depression | 150 mg | 150–300 mg | 400 mg |
| Older Adults Insomnia | 25 mg at bedtime | 25–75 mg | 100 mg |
For sleep, take 30–60 minutes before bed. For depression, usually taken in divided doses. Take with food to improve absorption and reduce dizziness. Avoid driving after taking until you know how it affects you.
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What to Expect — Timeline
1–2
Weeks 1–2
Body adjusting. May notice changes in sleep, appetite, or mild side effects
3–4
Weeks 3–4
Energy and motivation often improve before full mood lift
6–8
Weeks 6–8
Mood and anxiety typically improve significantly at a therapeutic dose
3–6m
3–6 Months
Full therapeutic benefit. Duration discussed based on your history and goals
⏳ Be patient. Most people need at least 4–8 weeks at a therapeutic dose before evaluating effectiveness. Do not stop without talking to your provider.
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Side Effects
Common (often temporary)
- Drowsiness or grogginess
- Dizziness
- Dry mouth
- Headache
- Blurred vision
- Constipation
- Nausea
- Low blood pressure when standing
Call us if you notice
- Priapism (prolonged painful erection — rare but requires emergency care)
- New or increased suicidal thoughts
- Abnormal heart rhythm (rare)
- Hypomania or mania
- Serotonin syndrome signs
Trazodone is generally very well tolerated at sleep doses. The most important rare side effect is priapism (a prolonged painful erection lasting more than 4 hours) — this is a medical emergency requiring immediate care. Morning grogginess can occur, especially at higher doses.
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Tips for Success
Same Time DailyTake at the same time each day for consistent levels in your system.
With FoodTaking with food can reduce nausea and stomach upset.
Don't Stop AbruptlyAlways taper slowly with your provider guidance to avoid withdrawal effects.
Limit AlcoholAlcohol worsens depression and anxiety and increases side effects.
Tell All ProvidersLet other prescribers know what you are taking — interactions matter.
Track Your MoodJournaling or a mood app helps you and your provider see what is changing.
Take Before BedTake 30–60 minutes before your target bedtime for best sleep results.
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Important Safety Information
Black Box Warning (under 25): Antidepressants may increase risk of suicidal thinking in children, adolescents, and young adults especially in the first few weeks. Monitor closely and contact us right away if new or worsening thoughts of self-harm appear.
Serotonin Syndrome: Can occur when combined with MAOIs, triptans, tramadol, or St. John's Wort. Signs include fever, agitation, rapid heart rate, and muscle twitching — seek emergency care immediately.
Drug Interactions: Do not take with MAOIs. Always share your full medication list with your provider.
Pregnancy & Breastfeeding: Discuss risks and benefits with your provider. Do not stop without consultation.
Priapism: A rare but serious side effect — a prolonged painful erection lasting more than 4 hours. This is a medical emergency. Go to the ER immediately if this occurs. Do not ignore it.
Cardiac Effects: Trazodone can affect heart rhythm at higher doses. Tell your provider if you have any heart conditions or take other medications that affect heart rhythm.
Orthostatic Hypotension: Trazodone can cause blood pressure to drop when you stand up quickly, causing dizziness or fainting. Rise slowly from sitting or lying positions.
Questions? I am here.
Reach me between appointments if you have concerns about side effects, notice mood changes, or have questions about your medication.
360-389-3712
info@rootedmindspsychiatry.com