Approved to treat major depression, trazodone (brand names: Oleptro and Desyrel) is also used to treat schizophrenia and used off-label to manage insomnia. Trazodone is considered an antidepressant medication with sedative-hypnotic effects. It works on serotonin reuptake inhibitors in the brain, which increase levels of the mood-lifting neurotransmitter. High levels of serotonin can make a person feel relaxed and pleasant, and trazodone helps to enhance this.
Like any mind-altering substance, trazodone is not without risks and side effects of use. The FDA medication guide for Oleptro publishes the following as potential side effects of trazodone: dizziness, priapism, respiratory arrest, ECG abnormalities, blurry vision, sleepiness, low blood pressure, vision issues, constipation, vomiting, feeling faint or passing out after standing up from a seated or prone position, mania, seizures, low sodium levels, or the possible onset of serotonin syndrome, which can cause hallucinations, mental confusion, coordination problems and difficulties walking, rapid heart rate, agitation, tight muscles, nausea, vomiting, and diarrhea. Trazodone may also increase suicidal ideations and thoughts in young adults, teenagers, and children, the US National Library of Medicine (NLM) warns. Taking too much trazodone at a time, or mixing it with other central nervous system depressant substances like alcohol, opioids, or benzodiazepine medications, can cause a toxic buildup in the brain and body and potentially cause a life-threatening overdose as well.
Taking trazodone for a long period of time increases the short-term risks and raises the potential for further long-term side effects. Trazodone may interfere with normal appetite and metabolism and lead to weight gain, for example. Long-term use of trazodone may help with insomnia symptoms, including nighttime awakenings and sleep difficulties; however, the Journal of Sleep Research warns that prolonged use of trazodone can also cause the following:
- Short-term memory dysfunctions
- Verbal learning issues
- Equilibrium disruption
- Next-day memory performance problems
- Difficulties with arm muscle endurance
Many of these side effects are felt the next day after taking trazodone for a long period of time and may be reversed after stopping the drug. Regular use of trazodone can also lead to drug tolerance, physical dependence, and difficult withdrawal symptoms when the drug wears off. Therefore, the drug shouldn’t be stopped suddenly without the supervision and direction of a trained medical professional. Trazodone may also have addictive potential, especially if the drug is misused. Trazodone abuse and addiction can have lasting side effects.
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Tolerance, Physical Dependence, and Trazodone Withdrawal
When you take a medication for a length of time that changes your brain chemistry and levels of neurotransmitters like trazodone does, your body can get used to its interaction in the brain and with the central nervous system. A tolerance can develop.
This can mean that you will need to keep upping the dose in order for the medication to keep working the same way. As the dosage increases, so do the odds of developing physical dependence on the medication. Physical dependence occurs when the brain can no longer regulate the levels of its chemical messengers itself without the disruption of the drug. If the drug isn’t present, like when it wears off and processes out of the body, withdrawal symptoms can kick in. Since trazodone increases serotonin levels in the brain, when a physical dependence forms, the brain can struggle to keep these levels balanced and within normal range without the interaction of the medication. Levels of serotonin can then drop when trazodone wears off, and withdrawal symptoms can be difficult.
The FDA reports the following as potential side effects of discontinuing Desyrel (trazodone):
- Trouble feeling pleasure
- Mood swings
- A ringing sound in ears
- Feelings of “shock” sensations
Irregular heart rate and blood pressure as well as depression and increased suicidal thoughts or actions can also be side effects of stopping trazodone use, especially if the medication is stopped suddenly after a dependence has formed. Trazodone is typically tapered off gradually as directed by a medical professional, slowly weaning the drug out of the body after a long time taking it (weeks to months or even years). Dependence is also progressive; the longer a person takes trazodone, the more pronounced the dependence will be and the more significant and prolonged the withdrawal symptoms can be.
Most withdrawal symptoms for trazodone will peak in the first day or two and then improve over the next 5-7 days. Some withdrawal symptoms like depression, anxiety, sleep disturbances, and mental “sluggishness” may linger for a few weeks to months after stopping trazadone, particularly in someone who has been taking it for a long period of time. The longer a person takes the drug for, the more pronounced the duration and symptoms of withdrawal can be.
A slow and controlled taper from trazodone during a specialized medical detox program can help to mitigate withdrawal symptoms that may occur if the drug is stopped “cold turkey.” Other medications may be used to manage withdrawal symptoms during detox as well, and supportive and therapeutic methods can be beneficial. Mood swings, cravings, and sleep issues that can be part of protracted withdrawal can all be addressed and helped through an addiction treatment program after medical detox.
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Addiction Involving Trazodone
The longer a person takes trazodone, and the more they take at a time, the more dependent the mind and body will be on the medication. The more significant the physical dependence, the more intense withdrawal can be.
Physical dependence is progressive and builds up more and more over time. The more dependent a person is on trazodone, the more likely they may be to struggle with controlling use, which may lead to trazodone misuse. The National Institute on Drug Abuse (NIDA) publishes that around 20 percent of American adults have abused a prescription medication – that is, they have used it outside of a medical need and legitimate prescription. Abusing trazodone can increase all of the possible side effects and raise the risk for dependence and addiction.
Trazodone is mind-altering and can create a pleasurable “high” when taken in large amounts and outside the bounds of a necessary prescription. The changes in brain chemistry that lead to tolerance and physical dependence after chronic use can lead to addiction, which the American Society of Addiction Medicine (ASAM) reports is a brain disease indicated by dysfunctions in brain chemistry and wiring, leading to an inability to control drug use. The effects of trazodone abuse, dependence, and addiction can cause issues with impulse control and motivation, thinking, learning and memory functions, and the ability to regulate emotions and feel pleasure.
Signs of addiction, as published by NIDA, include:
- Cravings for the drug
- Taking more of the drug at a time than initially intended and taking it for longer periods of time
- Multiple attempts and/or a deep desire to stop taking the drug without success
- Spending a lot of time working on getting the drug, using it, and recovering from its use
- Drug tolerance
- Drug use interfering with ability to regularly and consistently complete daily life obligations
- Using the drug despite the social and interpersonal consequences of doing so
- Continuing to use the drug knowing that it will be emotionally and/or physically damaging to use it
- Repeated use of the drug in situations that are physically dangerous
- Giving up important things and/or activities due to drug use
- Withdrawal symptoms
Addiction can cause a person to become withdrawn, socially isolated, and secretive. They will likely struggle to maintain personal relationships, suffer from unpredictable mood swings, and have disrupted sleeping and eating patterns and habits. A person struggling with trazodone addiction often makes poor choices that negatively impact their life on many levels. Risky behaviors can heighten the odds for accident, injury, criminal behaviors that can cause legal problems, unsafe sexual behaviors that may lead to the contraction of sexual or infectious diseases like hepatitis or HIV/AIDS, and financial difficulties due to lost workplace production and possible loss of employment.
Trazodone is also often abused with other drugs and/or alcohol, which can raise the risks and increase the potential side effects and complications of use. Trazodone abuse and addiction can also exacerbate mental health issues and actually increase anxiety, depression, and sleep difficulties in the long run.
Trazodone is considered a relatively safe medication for long-term use when used for medically necessary purposes under the direction and care of a medical professional. Trazodone abuse can be risky, however, and have a range of possible side effects. Trazodone abuse, dependence, and/or addiction can be managed through a rehab program that may use both pharmacological and therapeutic methods to foster a prolonged recovery.