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Trazodone Long-Term Side Effects

What Is Trazodone?

Sadness is a natural part of life. Grief over a breakup or the disappointment of a failure can cause one to be sad. Normally, a person’s mood will improve over time. When sadness or a low mood is persistent and unrelenting for weeks, months or years, the individual may be suffering from major depressive disorder.

Trazodone is an antidepressant primarily indicated for use in treating major depressive disorder but perhaps more commonly used off-label for managing insomnia. Previously available brand formulations include Desyrel and an extended-release tablet form, Oleptro.

As an atypical antidepressant, trazodone does not fit neatly into some of the more standard antidepressant classes (e.g., SSRIs, MAOIs, tricyclic antidepressants, etc.). Trazodone is sometimes categorized according to its mechanism of action, which is as a serotonin receptor (5HT2a) antagonist and reuptake inhibitor, or SARI.

While its precise mechanism of action is not fully understood, trazodone’s therapeutic benefit, like many modern antidepressant medications, is thought to start with an increase in serotonin activity throughout the brain. It is indicated for use (as mono-therapy or as an adjunct treatment) for major depressive disorder.

Trazodone is perhaps most widely used to manage insomnia (both depression-related and otherwise), but has additional off-label indications as an adjunctive pharmacotherapeutic for conditions like schizophrenia, anxiety, dementia, and Alzheimer’s.

How Common is Trazodone Abuse?

In the US, there’s been an increase in all prescription drug abuse, including abuse of antidepressants. According to the National Institute on Drug Abuse, over 20% of all Americans over age 12 had used a prescription drug for non-medical purposes at some point in their lives. While most people don’t misuse trazodone, it does happen.

According to an article in the Journal of Clinical Psychiatry, trazodone is thought to have a lower abuse liability than benzodiazepine drugs like triazolam or other hypnotics prescribed for insomnia, which may be why its off-label use for the treatment of insomnia has surpassed its use for the management of major depression.

The side effects of trazodone may be a concern and include symptoms such as orthostatic hypotention, priapism (painful, lasting erections), and cardiac arrhythmias. These side effects may be enough of a warning that some users want to discontinue the medication. Abruptly stopping, however, may trigger a discontinuation syndrome, with some characteristic of withdrawal symptoms.

Warnings and Risks

Because it is antidepressant, it is important to note the warnings and risks associated with trazodone before you take it:

  • The use of antidepressants is associated with a slight risk of serotonin syndrome, a potentially fatal condition characterized by changes in mental status, as well as neuromuscular and autonomic hyperactivity.
  • Trazodone may cause heart rhythm abnormalities. Patients with underlying cardiac conditions should discuss the risks of trazodone with their physicians.
  • Orthostatic hypotension (drop in blood pressure upon standing) and fainting may occur in some patients.
  • Prolonged, painful erections (priapism) may occur in some males taking trazodone.
  • Trazodone may increase bleeding risk, especially when combined with NSAIDs, such as ibuprofen.
  • Among patients with bipolar disorder, trazodone has the potential to activate manic/hypomanic states.
  • In rare cases, trazodone can worsen some of the symptoms of depression and may result in suicidal thinking.

These warnings apply to individuals taking trazodone as prescribed. Abuse of the drug may make an individual more likely to experience one or more of the above issues.

Long Term Effects of Trazodone

While trazodone is generally safe and effective when used as directed for its intended purpose, someone who misuses trazodone for extended periods of time may be at risk of experiencing more intense side effects, which may include:

An article in the Journal of Sleep Research states 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.

Long-term prescription use carries its own set of risks that may be outweighed by the benefits; however, if you are abusing the drug, you may be placing yourself at greater risk and may overdose.

What Happens if you Take Too Much Trazodone?

Taking too much trazodone at a time may be dangerous. An overdose may cause symptoms such as:

  • Hypotension (low blood pressure that may result in fainting).
  • Chest pain.
  • Trouble breathing.
  • Drowsiness.
  • Tremor.
  • Cardiac arrhythmias.
  • Seizures.
  • Coma.

Learn More about Trazodone Overdose Dangers

Trazodone Withdrawal Symptoms

Individuals may feel generally unwell when abruptly stopping trazodone. The symptoms of trazodone discontinuation syndrome may be worse for those who take more than the recommended dose.

Duration of use plays a role in how uncomfortable the withdrawal symptoms are as well, with those who use the drug for greater lengths of time potentially experiencing more intense symptoms.

Withdrawal symptoms that may arise from suddenly stopping trazodone may include:

  • Rapid mood swings.
  • Hypomania.
  • Irritability.
  • Anxiety.
  • Agitation.
  • Confusion.
  • Insomnia.
  • Dizziness.
  • Lethargy.
  • Headaches/migraines.
  • Ringing in the ears.
  • Blurred vision.
  • Nausea.
  • Sweating.
  • Paresthesia.
  • Seizures.

Because the drug is used to treat depression and insomnia, some symptoms of depression and sleep disturbances may return after stopping the drug.

How to Manage Trazodone Withdrawal?

In some instances, medical staff members may prescribe a taper to slowly wean the person off the medication. A tapered approach helps to reduce the symptoms of withdrawal. How long the taper will take will vary from person to person. Medical staff can discuss with you what you can expect.

In the case that someone is abusing several substances, medical detox may be recommended to manage troubling symptoms and prevent any medical complications. Once detox is complete, addiction treatment may be needed to address the underlying causes of compulsive substance use.

More On Long-term Effects:

Greenhouse Treatment Center has the experienced and licensed medical staff to help patients undergo treatment specific to their needs. If you find that you’re struggling with the misuse of trazodone, options are available. Together we can help you reach long-term sobriety one step at a time.

Sources:

  1. Harvard health Publishing. (2018). Major Depression.
  2. Food and Drug Administration. (2017). Highlights of Prescribing Information, Desyrel.
  3. Steven P. James, M.D., and Wallace B. Mendelson, M.D. (2004). The Use of Trazodone as a Hypnotic: A Critical Review. J Clin Psychiatry 65(6), 752-755.
  4. Alicia J. Roth, W. Vaughn M C Call, and Anthony Liguouri. (2011).
    Cognitive, psychomotor and polysomnographic effects of trazodone in primary insomniacs. J. Sleep Res, 20, 552–558.
  5. U.S. National Library of Medicine. (2018). Trazodone.
  6. Roth, A. J., McCall, W. V., & Liguori, A. (2011). Cognitive, psychomotor and polysomnographic effects of trazodone in primary insomniacs. Journal of sleep research, 20(4), 552–558.
  7. U.S. National Library of Medicine. (2017). Trazodone hydrochloride overdose.
  8. Volpi-Abadie, J., Kaye, A. M., & Kaye, A. D. (2013). Serotonin syndrome. The Ochsner journal13(4), 533–540.
  9. U.S. Food and Drug Administration. (2010). Highlights of Prescribing Information, Oleptro. 
About The Contributor
Scot Thomas, M.D.
Senior Medical Editor, American Addiction Centers
Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating... Read More