Table of Contents
What is Trazodone?
Before diving into trazodone withdrawal symptoms, one must understand what trazodone is. Trazodone is an antidepressant approved for the treatment of major depressive disorder by the FDA since 1981. Trazodone is classified as a selective serotonin reuptake inhibitor (SSRI) and treats depressive disorders. More specifically, trazodone is a serotonin receptor agonist and reuptake inhibitor (SARIs) that helps by balancing serotonin levels in the brain. 1
Serotonin is a neurotransmitter responsible for facilitating communication between cells and impacts our thoughts, moods, behaviors, energy levels, and sleep. SSRIs like trazodone work by regulating serotonin levels, helping improve energy levels, mood, and appetite. Physicians have also found trazodone positively impacts depression-related anxiety and insomnia.
Brand names for trazodone include Desyrel, Desyrel Dividose, and Oleptro.
Prescribing Trazodone Off-Label
Trazodone is federally approved to treat depressive disorders. However, physicians commonly prescribe this substance for off-label use in response to insomnia, panic attacks, and anxiety.
Many of trazodone’s off-label uses are based on physicians’ judgments and recommendations. They could benefit from additional studies to understand how effective these drugs are as solutions for their off-label uses.
Other off-label uses have included: 2
- Benzodiazepine or alcohol dependence
- Central nervous system degenerative diseases
- Chronic pain disease
- Sexual dysfunction
- Diabetic neuropathy
Trazodone also has shown significant promise in helping with alcohol dependence. During withdrawal, alcohol dependence can lead to symptoms of insomnia and cravings that trazodone has proven effective at remedying.
As an SSRI, it is almost impossible to develop a trazodone addiction in the same way other drugs do. However, trazodone can still lead to dependence.
If you decide to stop using trazodone, most physicians advise a tapering schedule. Going “cold-turkey” and not tapering this drug can lead to trazodone withdrawal due to sudden drops in serotonin production.
The FDA has issued trazodone a black box warning, as research shows that trazodone increases the risk of suicidal thoughts and behaviors among children and young adults. For this reason, doctors should closely monitor trazodone reactions.
Other common side effects of taking trazodone include:
- Nausea and vomiting
- Fatigue, drowsiness
- Weight loss
- Muscle aches
- Blurred vision
- Stuffed nose
- Dry or bad taste in the mouth
Although rare, more severe side effects can occur. If you or someone you know is experiencing persistent and severe trazodone side effects, call for emergency medical attention and support.
Serious risks include:
- Increased thoughts about suicide with heightened risk for children and young adults.
- Increased susceptibility to bleeding and bruising when taken with blood thinner medications such as Plavix, Warfarin, or Heparin.
- Changes in heart rhythm which is called cardiac arrhythmias.
- Hypotension – a sudden drop in blood pressure, like when quickly shifting from sitting to standing.
- Blurred vision.
- Mania, driven by feelings of hyperactivity, increased energy, and euphoria.
- Priapism – a painfully prolonged erection that lasts more than four hours and can require immediate medical attention to prevent permanent damage.
- Hyponatremia – an imbalance of sodium in the blood. Symptoms include confusion, lack of balance, weakness, headache, and seizures.
- Serotonin Syndrome – occurs when serotonin levels in the brain become too high. This risk increases when people take trazodone with other serotonin-boosting medications like migraine meds and SSRIs. Symptoms can include:
- Hallucinations and dizziness
- Agitation, increased heart rate, increased body temperature
- Seizures, tremors, muscle stiffness, balance issues
- Headaches, nausea, vomiting, diarrhea
- Discontinuation Syndrome. Although not addictive like benzodiazepines and other medications, trazodone still leads to physical dependence. If you decide to stop taking doses suddenly, withdrawal symptoms can occur. If choosing to stop using trazodone, consult with a physician to determine how to discontinue use safely.
Trazodone overdoses have been reported primarily in combination with alcohol, benzodiazepines, or other medications that act as depressants. When combined with other drugs that act on the central nervous system to generate feelings of drowsiness, trazodone overdoses can be fatal and require immediate medical attention.
If you believe you or someone you know is experiencing a trazodone overdose, call emergency services immediately.
Symptoms of a trazodone overdose include:
- Cardiac arrhythmia
- Nausea and vomiting
- Increased drowsiness
- Seizures (convulsions or blackout)
- Respiratory arrest
Trazodone Interactions with Other Drugs
While trazodone overdoses do occur, they are relatively rare. Often, such emergency room visits are related to interactions between trazodone and other supplements or medications. 3
Other antidepressants and drugs used to treat a depressive disorder, especially monoamine oxidase (MAO) inhibitors, can generate dangerous serotonin levels. People who have taken MAO inhibitors like linezolid, isocarboxazid, rasagiline, or phenelzine must wait at least fourteen days before beginning trazodone. Likewise, if discontinuing trazodone, people must wait fourteen days before taking MAO inhibitors. Other antidepressants such as SSRIs and SNRIs can increase the risk of serotonin syndrome.
Seizure medications like phenytoin may impact how long it takes to excrete trazodone and increase the amount of phenytoin in the body. They can lead to additional side effects, including mood changes, confusion, constipation, and balance issues.
Typically used to treat anxiety, seizures, and spasms, benzodiazepines are depressants that lessen brain activity and can combine dangerously with the drowsiness-inducing effects of trazodone.
Other Drug Interactions.
Drugs that impact the central nervous system (CNS) and increase feelings of drowsiness can interact dangerously with trazodone. These drugs include alcohol, cannabis, and antihistamines. Other depressants such as secobarbital and pentobarbital may heighten the impact of CNS depressants.
Certain antifungals (ketoconazole, itraconazole), macrolide antibiotics (erythromycin), HIV protease inhibitors (ritonavir, indinavir), rifamycin (rifampin), and supplements like St. John’s wort can also trigger side effects when combined with trazodone.
As discussed above, blood thinners like warfarin can lead to increased bleeding and bruising. Common nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen can also interact with trazodone to increase the risk of bleeding.
Additionally, taking the heart-rate regulating medication digoxin alongside trazodone can increase digoxin levels in the body, leading to side effects including vision problems, dizziness, vomiting, and irregular heart rate.
If you abruptly discontinue trazodone use, you’ll likely experience several withdrawal symptoms.
Symptoms of trazodone withdrawal include:
- Difficulty falling and staying asleep
Additionally, people using trazodone for a major depressive disorder may experience increased feelings of depression as they decrease use.
Trazodone Withdrawal Timeline
Trazodone has a half-life of five to nine hours and is typically entirely excreted by the body forty-five hours after the last dose. A drug’s half-life refers to the amount of time it takes the body to remove half the drug from the body. It takes most drugs four to five half-lives for the body to fully remove it.
The timeline for trazodone withdrawal depends on several variables, including the amount taken, period of use, and personal characteristics. If you’re working with a doctor to slowly and safely taper trazodone use, the process can take a few weeks up to three months.
Treatment for Trazodone Dependence
Fortunately, its limited potential for abuse means the likelihood of developing trazodone addiction from nonmedical use is rare. However, that does not mean it’s impossible to develop a dependency on trazodone.
Dependence is marked by withdrawal symptoms and a physical need for a substance to function optimally. Trazodone plays a vital role in helping the brain achieve and maintain healthy serotonin levels, so the body can get confused and experience side effects when trazodone is reduced or removed entirely.
If you are looking for help stopping or reducing trazodone use, there are several options available to you.
Your first step to recovering from trazodone dependence will likely be detox. Because trazodone withdrawal can bring serious side effects, medical supervision is advised when stopping trazodone use. Most physicians will suggest a trazodone tapering schedule, during which you slowly reduce your trazodone dose over weeks or months.
Outpatient vs. Inpatient Treatment
When paired with other drugs like alcohol or benzodiazepines, the risk of developing a trazodone addiction increases. Depending on your lifestyle, inpatient or outpatient programs can provide the needed support and structure to create new behavior patterns and emotional coping skills.
Inpatient programs help those who do not feel they have a safe home environment or strong support system to reinforce their recovery. Outpatient programs may be better suited for people who can’t take time away from work or are responsible for family members, making them unable to leave home for extended periods.
Treatment for trazodone dependence can involve a variety of therapies tailored to meet the needs of the individual. Therapies can include cognitive behavioral therapy, stress management, and group therapy geared towards strengthening emotional coping skills, recognizing behavior patterns, and developing healthier coping habits.