Trazodone as a Drug of Abuse
Certain classes of drugs have higher potentials for abuse and the development of physical dependence than others. Antidepressant medications, such as trazodone, have a relatively low potential for abuse and the development of physical dependence compared to drugs like narcotic medications (e.g., morphine, OxyContin, Vicodin, etc.), benzodiazepines (e.g., Valium, Xanax, Klonopin, etc.), stimulant medications, and alcohol. For many years, many prominent individuals in the mental health profession, medical profession, and pharmaceutical industry maintained that antidepressant medications were not potential drugs of abuse and did not have the potential to cause physical dependence. However, antidepressant discontinuation syndrome is a well-documented phenomenon, and many people now acknowledge that, although the risk is very low, there is some potential for antidepressant abuse.
According to the National Epidemiologic Survey on Alcohol and Related Conditions, as quoted in an article published by Substance Abuse and Rehabilitation, nonmedical use of a prescription drug is “use without a prescription, in greater amounts, more often, or longer than a doctor said you should use them. Individuals who continue to engage in nonmedical use of trazodone despite it causing them significant substance-related problems may have a substance use disorder.
It is currently recognized that antidepressant medications can be potential drugs of abuse. Nonetheless, the abuse of antidepressant medications is relatively rare and most often occurs in conjunction with abuse of other types of drugs, such as narcotic medications, benzodiazepines, stimulants, etc. The notion that antidepressant medications could be drugs of abuse was supported in 1994 by two case studies reported in the Mayo Clinic Proceedings that documented the abuse of the antidepressant Prozac and a case of co-abuse of trazodone.
A later study reported in the journal Psychopharmacology compared the abuse potential of Ambien, Halcion, and trazodone. The abuse potential of these drugs was rated by former drug abusers themselves as well as objective measures. Although the differences were not statistically significant, the participant-rated measures of abuse potential of trazodone (i.e. willing to take again, willing to pay for) were slightly higher than placebo, indicating trazodone may have some minimal potential for abuse. However, trazodone’s abuse potential was significantly less than those of Halcion and were also less than those of Ambien, which are both medications that are also used to induce sleep.
Individuals with substance use disorders who are unable to obtain their drug(s) of choice may resort to abusing any type of drug or medication in order to achieve some form of psychoactive effects. Since trazodone does produce mild sedation, and this is relaxing effect is sometimes interpreted as a mild, it is a potential drug of abuse. Individuals will occasionally grind up the drug and snort it, which is a sure sign of nonmedical drug use since this is not within the confines of its prescribed use.
It has also been recognized that antidepressant medications such as trazodone have the potential for the development of a mild syndrome of physical dependence, usually only if they are used for periods of six weeks or more. This syndrome of physical dependence that can occur as a result of antidepressant medications has been termed antidepressant discontinuation syndrome (ADS; more information about this syndrome will be presented below).
Who Abuses Antidepressants like Trazodone?
Overall, people who have a current or past substance use disorder, especially those in controlled environment such as correctional facilities, are more likely to abuse antidepressant medications like trazodone. In addition, those who use antidepressant medications for periods greater than 6-8 weeks may develop a mild physical dependence on the drugs. Some individuals may have difficulty stopping their use of the medication due to the withdrawal symptoms associated with physical dependence; however, these withdrawal symptoms are very mild and reported to be equivalent to a mild case of influenza.
Individuals who develop physical dependence on a medication as a result of prolonged use for medicinal purposes and have used the drug under the supervision of a physician are not considered to have substance use disorders. A substance use disorder by definition indicates that the individual is engaging in nonmedicinal use of a drug or medication, and this abuse results in negative consequences for the individual.
Antidepressant Discontinuation Syndrome (ADS)
Substance dependence, according to the DSM-IV-TR, may include both the symptoms of tolerance (needing more of the substance to produce effects that were once produced at lower doses) and withdrawal (a series of negative effects that occur when an individual stops using a drug or cuts down on the dosage). ADS denotes the withdrawal portion of the physical dependence syndrome.
Many individuals will develop a low-level tolerance to antidepressant medications after they take them for extended periods and may need to have their dosage adjusted. In addition, a number of individuals who use antidepressant medications for periods of longer than 6-8 weeks may develop ADS. The symptoms of ADS are quite varied and may include:
- Mood swings that resemble the symptoms of clinical depression
- Somatic symptoms, such as insomnia, dizziness, mild headache, fatigue, and other flu-like symptoms, such as muscle aches, nausea, and sweating
- Vivid dreams or nightmares
- Hallucinations, in rare cases
The duration of ADS appears to be relatively short with a a median of about five to ten days, though it can range from one day to several weeks. The symptoms are generally considered to be mild. Although ADS appears to be associated with nearly any type of antidepressant medication, it is more likely with antidepressants that have shorter half-lives and with longer treatment duration.
The best strategy to avoid the symptoms of ADS is to discontinue trazodone under the supervision of a medical professional. Medical professionals typically employ tapering strategies where successively lower doses of the drug are administered until the individual is weaned off the medication with minimal effects.
Some individuals who may be emotionally unstable may be at risk for self-harm due to the effects of ADS. This can occur as a result of an accident, poor judgment, or even rare cases of individuals becoming distraught and engaging in intentional self-injurious behavior or suicidal behavior. It is also very difficult to predict who will develop rare symptoms, such as vivid nightmares or hallucinations. For these reasons, it is suggested that anyone who is using or abusing an antidepressant medication and wishes to discontinue use of the medication do so under the supervision of a physician.
Indicators of Abuse
Signs that an individual may have a substance use disorder that involves trazodone include:
- A person does not have a prescription but uses trazodone on a regular basis
- A person with a prescription for trazodone attempts to get more than they are prescribed to use (e.g., via buying it illegally, stealing it, or trying to get different physicians to write prescriptions for the drug)
- Taking trazodone in ways the drug is not intended to be taken, such as grinding it up and snorting it
- Using trazodone in conjunction with other drugs of abuse
- Continuing to use trazodone despite negative consequences as a result of its use
- Use of trazodone affects one’s health or psychological wellbeing
Treatment for Trazodone Addiction
As mentioned above, the most likely scenario that occurs when individuals are abusing trazodone is that they are abusing multiple drugs. When individuals develop substance use disorders to multiple substances, this complicates treatment. A good number of these individuals will have co-occurring psychological disorders in addition to their polysubstance abuse. These individuals will require a comprehensive psychological assessment and physical examination to determine the extent of their substance abuse, any other psychological issues that co-occur with the substance abuse, and any physical ailments or ill effects associated with these conditions.
After an assessment, a withdrawal management program is advised to assist the individual in discontinuing all drugs of abuse. An integrated treatment approach that emphasizes a multidisciplinary team approach to care should be employed. This may include physicians, psychologists, counselors, social workers, and other mental health workers to address the specific issues involved. A long-term aftercare program is essential; this program should be designed to help the individual adjust to life in recovery and lower the potential for relapse.