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Trazodone Long-Term Side Effects

Trazodone—formerly branded Desyrel and Oleptro—is an antidepressant used for major depressive disorder. Previously available brand formulations include Desyrel and an extended-release tablet form, Oleptro. As an atypical antidepressant, trazodone does not fit neatly into to 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 if 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. Trazodone is indicated for use (as monotherapy or as an adjunct treatment) for major depressive disorder. It 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.

Trazodone Abuse – How Common Is It?

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 nonmedical 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. However, 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 withdrawal symptoms.

Long-term Trazodone Risks – Warnings & Side Effects

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.

Trazodone Overdose

Taking too much trazodone at a time may be dangerous. Overdose has been may to cause symptoms such as:

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

MORE ON LONG-TERM EFFECTS:

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 Is Trazodone Withdrawal Managed?

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.

Sources:

  1. Food and Drug Administration. (2017). Highlights of Prescribing Information, Desyrel.
  2. 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.
  3. 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.
  4. U.S. National Library of Medicine. (2018). Trazodone.
  5. Roth, A. J., McCall, W. V., & Liguori, A. (2011). Cognitive, psychomotor and polysomnographic effects of trazodone in primary insomniacs. Journal of sleep research20(4), 552–558.
  6. U.S. National Library of Medicine. (2017). Trazodone hydrochloride overdose.