Trazodone for Anxiety: Use, Effectiveness and Side Effects

trazodone for anxiety

Trazodone is an antidepressant medication that was developed in Italy in the 1960s. (1) When the antidepressant was first introduced, the medical community didn’t appreciate it because of side effects like dizziness, fainting, and an irregular heartbeat associated with the drug.

However, doctors and internists gradually learned about the drug’s potential benefits, especially when given at low amounts. In 1981, the U.S. Food and Drug Administration (FDA) approved trazodone for treating major depressive disorder under the brand name Desyrel. (2)

Since the FDA has not yet approved trazodone as an anxiety treatment, it can be prescribed off-label. Trazodone is expected to lessen anxiety by influencing the relevant neurotransmitters. Antidepressants like Zoloft for anxiety, however, are more typically used as first-line anxiety medications, but you can also consider trazodone for anxiety for its off-label usage.

It can improve your stamina level, appetite, and mood while reducing anxiety and insomnia. Today, the medication is widely used to treat insomnia, unipolar depression, and anxiety disorders.

How does Trazodone Work for Anxiety?

Trazodone boosts the central nervous system’s natural neurotransmitters. Serotonin is one of these crucial neurotransmitters that deliver signals between nerve cells in the brain and other body parts. (3) It alters the neurotransmitters in the brain by activating some nerves while blocking the uptake of serotonin by others.

Serotonin plays a critical role in many vital physiological processes, including maintaining our circadian rhythm and strengthening digestion, sleep, appetite, memory, sexual function, and skeletal health, in addition to boosting mood and reducing anxiety. (4) According to research, lower serotonin levels have been linked with an elevation in depression, anxiety, and other mental health issues. (5

Trazodone belongs to the group of drugs known as serotonin antagonists and reuptake inhibitors (SARIs), also known as serotonin modulators or phenylpiperazine antidepressants. (5) It selectively prevents dopamine, norepinephrine, and serotonin from reuptake at particular serotonin receptors, such as the 5-HT2A receptor. This process results in a potential increase in the amount of serotonin, norepinephrine, and dopamine that may pass through nerve cells. These elevated serotonin levels result in a healthier, more coordinated brain, which can help manage depression, anxiety, and sleep problems.

According to clinical trials, the effectiveness of trazodone is on par with that of other medication classes like TCAs, SSRIs, and SNRIs. However, trazodone has better tolerability than second-generation SSRIs, which are strongly linked to sexual problems, insomnia, and anxiety.

Effectiveness of Trazodone

Trazodone’s ability to effectively reduce anxiety while also addressing insomnia and other mental health issues has been demonstrated in several earlier research.

In persons with generalized anxiety disorder, trazodone reduced anxiety at a level comparable to diazepam, according to 1993 research. (6) Another study from 1987 discovered that trazodone treatment reduced symptoms in a limited group of patients of agoraphobia or panic disorder who experienced panic episodes. (7) Another study discovered that trazodone might lessen nightmares and insomnia brought on by post-traumatic stress disorder. (8)

All these studies collectively demonstrated that trazodone could help manage anxiety and other associated symptoms.

trazodone for anxiety

Other Off-label Uses of Trazodone

Trazodone is an FDA-approved antidepressant that can be used alone to treat depression or in conjunction with other medications or psychotherapies, such as cognitive behavioral therapy to treat major depressive disorders. However, trazodone has several well-known off-label uses that are not FDA-approved, in addition to treating anxiety, including the following:

Trazodone for Insomnia

The medication has a sedative effect on many people, resulting in a relaxed, sleepy feeling. The drug is increasingly widely used for patients with severe insomnia as a bedtime sleep aid. (9)

 In order to reduce the symptoms of sleepiness, doctors often advise taking a modest dose of the medication at bedtime when prescribing it for sleep disturbances. However, some people experience persistent side effects after waking up with anxiety, including sluggishness and a lack of energy. 

Trazodone for PTSD

Studies have shown that patients with panic symptoms have occasionally experienced an exacerbation, which is why SSRIs—rather than trazodone—are favored as the first-line therapy for PTSD. However, trazodone can also be utilized if SSRIs are ineffective as a first-line treatment for post-traumatic stress disorder (PTSD). Studies involving PTSD patients have been shown to lessen nightmares and enhance sleeping patterns. But first, consult a medical expert before taking trazodone for PTSD. (10)

Trazodone can also be used off-label for conditions like Alzheimer’s disease, substance abuse, bulimia, and fibromyalgia because of its actions on serotonergic receptor antagonism and serotonin reuptake inhibition.

How to Use Trazodone?

Read the prescription guide included with the drug before you start using trazodone. Take this medication by mouth as directed by your doctor, usually once or twice daily, after a meal or snack. Take it before night if you only take one dose a day and dizziness is a problem. Take one of your daily dosages before bed; it will be very convenient.

Your dosage will be based on your medical condition and how well you respond to treatment. In order to reduce your risk of adverse effects, your doctor may start you on a lower dose and then progressively increase it. Trazodone can be taken two to three times daily, 50 mg to 100 mg, to alleviate anxiety. The total daily dosage shouldn’t exceed 400 mg. An initial dose of 50 to 100 mg is recommended before night if you are using it for sleep issues. The dose can be increased to 200 mg at bedtime if more is required. Those who experience both anxiety and sleep problems may require a higher dose, up to 300 mg at bedtime.

Take this drug precisely as prescribed. Use this medicine as directed; do not take it more often or excessively. There’s a risk that you’ll encounter more severe side effects, and your condition won’t get improved any faster. If you forget and need to take a dose, do so immediately. In cases where the next dose is almost due, skip the missed dose. To make up for missed doses, take your next dose at the appointed time rather than doubling it.

Even if you start feeling betterment in symptoms, keep taking this medication as prescribed. To make sure you recall to take it, take it at the same time each day. Avoid stopping this medication abruptly without first seeing your doctor since anxiety and trouble falling asleep may ensue.

trazodone for anxiety

How Long does it Take for Trazodone to Work?

Owing to the drug’s prolonged approach to reducing your anxiety, do not anticipate feeling better overnight. Trazodone can take up to two weeks to start working, and it can take another four to six weeks to achieve its full effects. Allow the medication to affect your body for at least six weeks fully. Additionally, it’s possible that you will experience severe side effects in the initial stages of treatment before you start to feel better. You must maintain patience throughout.

The medicine quickly produces its sedative effects. Depending on the drug’s type, patients who take it for insomnia or another sleep difficulty can get the required results in 30 minutes to 2 hours.

How does Trazodone Make you Feel? 

For the first several days after starting trazodone, you could feel sleepy. Antidepressant trazodone might improve your mood and help you relax. You will realize that you sleep better and interact with people more quickly since you’re less anxious. Hopefully, the things that used to disturb you won’t bother you as much.

The sleepy effects of trazodone typically start to kick in within 30 minutes after taking the medication. However, excessive consumption might result in feelings of excessive excitement, exhilaration, and hyperactivity.

Low doses of trazodone can aid in helping you get to sleep and stay asleep at night without building a tolerance or making you sleepy during the day. These effects of the medicine typically last between three and six hours.

Is Trazodone Addictive?

Trazodone can still be overused, and dependency may happen, despite being generally harmless and effective. Trazodone is not a regulated substance and is not an addictive drug.

However, patients run the danger of overdosing or developing withdrawal symptoms if they do not adhere to the medication’s clear instructions. If you regularly take trazodone over an extended period, your body adjusts to the drug’s presence; this is distinct from addiction and is known as physical dependency.

Trazodone is an extended-release drug. Its use for months or years is not intrinsically harmful but can lead to dependence. A person has developed a dependence when they require Trazodone to function normally or when they experience withdrawal symptoms if they stop taking it. 

Nevertheless, unpleasant withdrawal symptoms may occur in patients who discontinue using Trazodone abruptly. To prevent withdrawal symptoms if you no longer want to take this drug, talk to your doctor about gradually cutting back on your dosage until it is okay to stop taking it altogether.

Is Trazodone Safe for a Pregnant or Nursing Mother?

Your and your baby’s health can be directly impacted by anxiety, which can occasionally worsen throughout pregnancy and after giving birth. It is crucial that anxiety is properly handled during nursing and pregnancy.

If you get pregnant while taking trazodone, consult your doctor. They will assist you in weighing the risks and rewards so you may choose the best course of action for you and your unborn child. If your doctor has not instructed you to stop taking your medication, do not. (11)

You can take trazodone while nursing if your doctor confirms that your infant is healthy. There are no known adverse effects associated with trazodone in breastfed infants, and very little of it enters the milk.

Even though other medications could be favored when you’re nursing, you must use the medication that works for you. See your doctor or pharmacist for assistance in deciding what is best for you if you are breastfeeding or intend to breastfeed. (12)

Consult your doctor immediately if you observe that your infant is not feeding or becomes grumpy, tired, or irritated for no apparent reason.

Is Mixing Trazodone with Other Drugs or Alcohol Safe?

Since trazodone and alcohol both affect the central nervous system, combining the two can have fatal results. Trazodone may intensify alcohol’s effects, causing potentially fatal overdoses and severe degrees of intoxication. (13)

Due to the combined adverse effects of their medication interactions, using them simultaneously can be dangerous. Extreme sleepiness, which can result in accidents and falls, can also be brought on by the combination.

Interactions of Trazodone with Other Drugs

Drug interactions can alter how well your treatments work or put you at risk for significant adverse effects. Not all conceivable medication interactions are included in this list. The potential interactions are present there, though. Without consulting your doctor beforehand, never start, stop, or modify the dosage of any medications.

Trazodone with MAO Inhibitors

Using this medication along with MAO (monoamine oxidase) inhibitors may result in a dangerous and fatal drug interaction. When taking this drug, avoid MAO inhibitors. The majority of MAO inhibitors should be avoided for two weeks before and following treatment with this drug. Always consult your doctor if you are thinking of beginning or stop using the drug. (14)

Trazodone with Anticonvulsants

When trazodone is consumed with anticonvulsants like gabapentin, commonly used for anxiety, the likelihood of experiencing side effects increases; common side effects may include tiredness, disorientation, and difficulties concentrating rise. In certain persons, especially the elderly, thinking, judgment, and motor control may also be impaired. (15)

Trazodone with Other Antidepressants

SSRI and SNRI antidepressant combinations with trazodone may help increase efficacy; however, increasing the dose of these medications can result in a dangerous condition called serotonin syndrome. (16) Combining some antidepressant medications with those that alter synaptic serotonin levels most frequently results in serotonin syndrome. Drug interactions, which can result in potentially severe serotonin intoxication or serotonin syndrome, may happen when individuals are given multiple antidepressants at a time from distinct pharmacologic classes. (17)

Before starting trazodone, inform your doctor or pharmacist if you are taking other sedatives. Alcohol, marijuana, antihistamines, sleep or anxiety medications, muscle relaxants, or opioid painkillers could negatively affect your body if they interact with trazodone.

trazodone for anxiety

Side Effects of Trazodone

Trazodone may result in adverse effects, like with all drugs. Although most adverse effects are temporary and not life-threatening, there are some instances where the medicine can have more severe side effects that necessitate medical treatment.

The most frequent adverse reactions to trazodone are impaired vision, fatigue, drowsiness, sweating, swelling, losing weight, muscle pain, dry mouth, constipation, and decreased libido. Inform your doctor or pharmacist immediately if these side effects persist or worsen.

Skin rashes, rapid or sluggish heartbeats, difficulty breathing, fainting spells, bruises or unusual bleeding, and low sodium levels in the body are some severe and uncommon adverse effects that could occur. Even though allergic responses are uncommon, they are possible. They can be lethal and call for immediate medical care. If you see any of these symptoms, go to the doctor immediately.

Another dangerous side effect of trazodone that can result from overdose is priapism, a severe condition in which the penis or clitoris persists in an erect state for a lengthy period. (18) Sometimes, priapism can lead to impotence or a permanent loss of erectile function. Patients should be made aware of the possibility of priapism and instructed to discontinue the drug immediately.

Moreover, consumers are informed about a prescription drug’s potentially harmful side effects using a black box warning. It claims that Trazodone can cause or worsen suicide ideation in adolescents and youngsters. (19)

Precautions

  • If you have any allergies, let your doctor know before administering trazodone. Inactive components in this medication can trigger allergic reactions or other complications.
  • Tell your doctor about any illnesses you have had in the past, particularly bipolar disorder, a personal or familial record of suicide attempts, cardiovascular disease, liver problems, renal disease, high blood pressure, or diabetes. All of these conditions may affect how the medication works for you.
  • This medicine may cause you to feel tired, sleepy, or have blurred vision. Driving, using machinery, or performing other tasks requiring attention or clear vision should all be avoided until you can do so safely.
  • Discuss the benefits and drawbacks of using this medicine during pregnancy with your doctor as soon as you learn that you are pregnant or plan to become pregnant.
  • Do not abruptly stop taking this medication, as it could cause withdrawal symptoms. If you want to discontinue using it, talk to your doctor.

trazodone for anxiety

Conclusion

Although anxiety is normal, it should never be ignored if it is recurrent and seriously impacts your life. Medications are the best approach for treating anxiety.

For treating the major depressive disorder, the FDA has approved the antidepressant drug trazodone. Aside from its approved uses, your doctor might also recommend it to treat sleeplessness and anxiety. When the initial treatment plan is ineffective, you should consider this.

Although this medication has no addiction-inducing adverse effects, it can cause drowsiness, headaches, and other common side effects. Take trazodone exactly as your doctor prescribes, and let them know immediately if you experience any severe adverse effects.

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