Trazodone for Sleep and Depression

Introduction to Trazodone

The American Academy of Sleep Medicine notes that trazodone 50mg has limited efficacy for sleep onset and maintenance insomnia, with modest reduction in sleep latency (10.2 minutes) and increased sleep diary total sleep time (21.8 minutes), both below clinical significance threshold, and wake after sleep onset reduced by only 7.7 minutes 1
The American Academy of Sleep Medicine suggests clinicians not use trazodone for sleep onset or maintenance insomnia (weak recommendation) 1

Sedation is the most common side effect, with headache reported in 30% vs 19% in placebo, and somnolence reported in 23% vs 8% in placebo 1
Trazodone can cause excessive sweating as a side effect, particularly when used at higher doses for depression treatment, according to the American Academy of Family Physicians guidelines 2
Rare but serious side effects of trazodone include priapism, orthostatic hypotension, cardiac arrhythmias, and serotonin syndrome, particularly when combined with other serotonergic medications 2, 3

The American Academy of Sleep Medicine recommends considering alternative treatments, such as FDA-approved medications like zolpidem, eszopiclone, or zaleplon, for patients requiring medication for insomnia, after considering cognitive behavioral therapy for insomnia (CBT-I) 1
CBT-I is recommended as the first-line treatment for insomnia, due to its effectiveness and lack of adverse effects, as stated by the American Academy of Sleep Medicine and the American College of Physicians 1, 4, 5
FDA-approved medications, such as zolpidem, eszopiclone, and zaleplon, can be used as second-line treatments for insomnia, with the following dosages:
Medication Dosage
Zolpidem 10mg (5mg in elderly)
Eszopiclone 2-3mg
Zaleplon 10mg
Ramelteon 8mg
Suvorexant 10-20mg
1, 4, 5
Sedating antidepressants, such as trazodone, doxepin, mirtazapine, or amitriptyline, can be considered as third-line treatments for insomnia 4
When prescribing trazodone, consider the following: 2, 4