Trazodone

Uses

What is trazodone used for?

Trazodone is used to treat depression.

Trazodone may also be used for other conditions as determined by your healthcare provider.

How does trazodone work (mechanism of action)?

Trazodone is an antidepressant that belongs to a group of medicines called serotonin modulators. It works by increasing the amount of serotonin, a natural chemical in the brain.

How is trazodone supplied (dosage forms)?

Trazodone is available in the following dosage forms that are taken by mouth.

• 50 mg tablets
• 100 mg tablets
• 150 mg tablets
• 300 mg tablets

How should I store trazodone?

Trazodone should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C), for shorter periods of time, such as when transporting it. Store in a cool, dry place, in a tightly closed container. Protect from light.

Trazodone (brand name Desyrel) is an atypical antidepressant that's used somewhat differently than most other antidepressants nowadays.

Primary uses today:

• Insomnia (most common current use, at low doses 25-100mg)
• Major depression (at higher doses 150-300mg+)
• Anxiety
• Sometimes agitation in dementia

How it works: Primarily affects serotonin, but in a different way than SSRIs. It also has antihistamine properties that cause sedation, which is why it's so popular for sleep.

Characteristic effects:

• Very sedating (this is the main feature)
• Helps with sleep onset and maintenance
• At higher doses, antidepressant effects
• Generally doesn't cause weight gain or sexual side effects like SSRIs

Common side effects:

• Drowsiness/grogginess (especially morning hangover at higher doses)
• Dizziness, lightheadedness
• Dry mouth
• Low blood pressure (especially when standing up)
• Headache

Rare but serious:

• Priapism (prolonged, painful erection) - medical emergency, happens in ~1 in 6,000 men
• Cardiac arrhythmias at high doses

In the context of schizoaffective disorder:

Trazodone is frequently used as an add-on medication for:

Sleep problems - which are extremely common with:

• The condition itself (mania disrupts sleep, depression affects sleep, psychosis can interfere)
• Side effects from antipsychotics (some are activating, some sedating but cause poor quality sleep)
• Anxiety that prevents sleep

Why it's preferred for this population:

• Doesn't worsen psychosis (unlike some sleep medications)
• Doesn't interact badly with antipsychotics typically
• Low addiction potential (unlike benzos or Ambien)
• Can help with anxiety without adding another heavy medication

Typical use pattern:

• Usually 25-100mg taken 30-60 minutes before bed
• Can be increased if needed
• Works quickly (not like antidepressants that take weeks)
• Often combined with medications like Invega, Pristiq, Wellbutrin without major interactions

Practical notes:

• Start low - even 25mg can knock some people out
• Take on empty stomach or light snack (food increases absorption unpredictably)
• Hangover effect is dose-dependent
• Tolerance to sedation can develop, but usually remains effective for sleep

Compared to other sleep options:

• Safer than benzos for long-term use
• Less habit-forming than Ambien/sleep aids
• More sedating than melatonin or antihistamines
• Less metabolic side effects than antipsychotics used for sleep (Seroquel, olanzapine)

So in a regimen with Invega (antipsychotic), Pristiq (antidepressant/SNRI), and Wellbutrin (activating antidepressant), trazodone would make sense as a sleep aid - especially since Wellbutrin can cause insomnia, and managing sleep is crucial for mood stability in bipolar presentations.