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What is Trazodone?

Trazodone is an FDA-approved antidepressant for treating major depressive disorders. Brand names- Desyrel, Trittico, Oleptro, Molipaxin, Trazorel (among others). It is a prescription drug that can be used as part of combination therapy with other medications or psychotherapies or used by itself for treating depression. Non-FDA-approved use is to induce sedation in patients with sleep problems and sleep anxiety. These patients may or may not have concurrent depression or anxiety. Trazodone is not FDA-approved for sleep disorders, because of a lack of sufficient clinical data for justifying its use as a sleep aid

Because of its serotonergic receptor antagonism and serotonin reuptake inhibiting effects, Trazodone is also used off-label for Alzheimer’s disease, anxiety, substance abuse, fibromyalgia, and bulimia. Trazodone has also been used for post-traumatic stress disorder (PTSD) if the first-line treatment use of SSRIs does not show efficacy. The dose of 50 mg to 200 mg of Trazodone has been demonstrated to reduce episodes of nightmares as well as improve sleep habits in studies involving PTSD patients.

Do not use this medicine if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could happen. MAO inhibitors include linezolid, isocarboxazid, methylene blue injection, phenelzine, tranylcypromine, and others. Tell your doctor if you also take opioid medicine, stimulant medicine, herbal products, or medicine for mental illness, depression, Parkinson’s disease, migraine headaches, serious infections, or prevention of nausea and vomiting.

Trazodone Side Effects
Long-term use of Trazodone and alcohol may result in physical dependence and withdrawal symptoms.

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What is Trazodone Used for?

Trazodone is an antidepressant that works by inhibiting both serotonin type 2 receptors and serotonin transporter. It is a triazolopyridine derivative. Trazodone inhibits the reuptake of serotonin and blocks the histamine and alpha-1-adrenergic receptors. It also induces significant changes in 5-HT presynaptic receptor adrenoreceptors. Trazodone is in the category of SARI drugs (serotonin antagonist and reuptake inhibitors), with other members being etoperidone, phenylpiperazine, lorpiprazole, and mepiprazole.

Trazodone administration is via the oral route. It may be taken after meals to decrease postural hypotension and lightheadedness. Trazodone may be available as immediate-release (IR) tablets, prolonged-release tablets, and in some cases, injection and oral drops solutions. It can take one to two weeks before trazodone starts to work, but maybe four to six weeks before you feel the full benefit.

Trazodone uses can also include treatment for the effects of alcohol withdrawal, anxiety treatment, medications for schizophrenia treatment, and uncontrolled movements resulting from side effects from other medications. Trazodone for pain is also frequent off-label use of the drug, and in particular, it can be useful for chronic pain conditions like fibromyalgia. In many cases, individuals who have chronic pain are given antidepressants and medications that control the pain itself. This is because of the effects chronic pain can have on mood and the likelihood of developing depression.

Trazodone should not be used in patients with a history of heart disease or a recent heart attack. This medication can cause or worsen QT prolongation (a disorder of the heart), which can cause an irregular heart rhythm that can lead to seizures, fainting, or even death.

Trazodone for Sleep Disorder

Trazodone is not classified by the FDA as a controlled substance, unlike medications such as Lunesta and Ambien. This means that Trazodone is not considered to have a potential for abuse and misuse. Due to the fact that trazodone is not classified as a controlled substance, doctors do not have strict limits on how many pills they’re able to prescribe.

Trazodone for sleep disorder treatment medication has the advantage of being an effective treatment for insomnia. Trazodone is helpful at low doses for primary and secondary insomnia. Moreover, it is less expensive than some newer insomnia medications due to its generic availability, At low doses, trazodone as a sleep aid is often very effective for insomnia.

Dose of Trazodone 

Before prescribing Trazodone, your doctor will ask you if you have any allergies and what other medications you are taking. This is to make sure that the Trazodone will not cause an allergic reaction or interact with the other drugs. You must mention if you or they have heart, kidney, or liver disease, blood pressure problems, or a history of glaucoma. Also, if you have a history of substance abuse.

As Trazodone can cause dizziness, drowsiness, and blurred vision, your doctor will advise you not to drive or use machinery until these symptoms pass. If you smoke marijuana, you should tell your doctor, smoking marijuana or drinking alcohol can increase the dizziness which is sometimes experienced when taking Trazodone.

According to the Food and Drug Administration (FDA), dosing should be as follows:

  • For the treatment of depression, a normal starting dose is 150 milligrams (mg) per day. When the regular tablets are taken, this would most likely be scheduled as 75 mg in the morning and 75 mg at night.
  • For the treatment of insomnia, the dose is usually started with 25 to 50 mg at night.

Your healthcare provider will then work with you to find the right dose and may increase your dose every few days. Check your prescription and talk to your healthcare provider to make sure you are taking the right dose for you.

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Trazodone Side Effects

Trazodone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation
  • Changes in appetite or weight
  • Weakness or tiredness
  • Nervousness
  • Dizziness or lightheadedness
  • Nightmares
  • Muscle pain
  • Dry mouth
  • Rash
  • Sexual problems in males; decreased sex drive, inability to get or keep an erection, or delayed or absent ejaculation
  • Sexual problems in females; decreased sex drive, or delayed orgasm or unable to have an orgasm
  • Uncontrollable shaking of a part of the body
  • Stuffy nose
  • Tired, red, or itchy eyes

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment:

  • Chest pain
  • Fast, pounding, or irregular heartbeat
  • Loss of consciousness (coma)
  • Fever, sweating, confusion, fast or irregular heartbeat, and severe muscle stiffness or twitching, agitation, hallucinations, loss of coordination, nausea, vomiting, or diarrhea
  • Fainting
  • Seizures
  • Shortness of breath
  • Unusual bruising or bleeding
  • Nosebleeds
  • Small red or purple dots on the skin
  • Erection lasting more than 6 hours
  • Headache
  • Problems with thinking, concentration, or memory
  • Weakness
  • Problems with coordination
Trazodone Side Effects
Although trazodone overdose is less common, it can happen when you mix alcohol and the drug.

Trazodone Interactions 

While a trazodone high isn’t a reported effect with this drug, However, if you mix it with other substances, it can amplify the effects of those. For example, if you combine trazodone and alcohol it can increase your responsiveness to the alcohol. This can occur with any type of central nervous system depressants, which is why it’s important to let your doctor know of any other substances you use before taking trazodone.

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. 

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Serotonin Syndrome

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/”ecstasy,” certain antidepressants (including SSRIs such as fluoxetine (Prozac), SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.

Clinical symptoms of serotonin syndrome can develop within two hours—or up to 24 hours—after taking an increased dose or adding another serotonergic drug.

Signs and symptoms of serotonin syndrome:

  • Tremors
  • Muscle aches
  • Sweating
  • Anxiety
  • Confusion
  • Tachycardia
  • Delirium
  • Hallucinations
  • Seizures
  • Renal failure
  • Death

Trazodone and Alcohol

Drinking alcohol while taking trazodone can be dangerous. Trazodone may amplify some of the effects of alcohol, which can lead to dangerous levels of intoxication and even overdose and death. The combination can also cause extreme drowsiness, which can lead to accidents and injuries. In addition, alcohol can increase the risk of depression, anxiety, and other mental health problems such as anxiety disorders, depression, and suicidal thoughts. Some users who have mixed trazodone with alcohol claim the combination impairs their thinking and judgment. Alcohol is a depressant and mixing an antidepressant with a depressant can lead to unpredictable and dangerous consequences for different users.

Trazodone and Alcohol Withdrawal

Long-term use of alcohol and trazodone can also lead to the development of physical dependence and withdrawal symptoms. Trazadone withdrawal symptoms can include agitation, anxiety, and sleep problems. Instead of quitting cold turkey, people on the medication are advised to be tapered or gradually weaned off under the care of a physician.

The severe alcohol withdrawal syndrome can be quite serious and can include symptoms such as alcohol-induced insomnia, increased body temperature, anxiety, rapid pulse, sweating, nausea, and vomiting, as well as more severe complications such as hallucinations or alcohol-induced psychosis, agitation, delirium, and seizures. Left unmanaged, alcohol withdrawal can even be life-threatening due to the possibility of grand mal seizures.

Individuals who have become dependent on alcohol and Trazodone may need medically-supervised withdrawal management and detox—either as part of a standalone program or at the start of a rehabilitation program. Medical-supervised detox programs are staffed with healthcare professionals who can monitor the individual’s recovery during the withdrawal process and provide therapeutic interventions when needed.

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Treatment for Trazodone Side Effects and Alcohol Abuse 

To determine the most effective ways to treat Trazodone side effects and co-occurring alcohol addiction, it’s crucial to first get an accurate assessment of all the symptoms. When the symptoms have been evaluated by a mental health professional, it may be determined that another form of depression is present and needs a particular type of treatment. Very often, some combination of medication, psychotherapy, and/or lifestyle changes are effective for coping with functional.

Medically-Assisted Detox

Detox is often considered the first stage of treatment. It will help you navigate the complicated process of alcohol withdrawal, but it doesn’t address patterns of thought and behavior that contribute to alcohol use. Various treatment approaches and settings can help provide the ongoing support necessary to maintain long-term sobriety after you complete detox.

Cravings are very common during detox and can be challenging to overcome. This often leads to relapse. Constant medical care provided during inpatient treatment helps prevent relapse. Clinicians can provide necessary medication and medical expertise to lessen cravings and the effects of alcohol withdrawals.

Psychotherapy for Depression

Several different modalities of psychotherapy have been used in the treatment of depression including:

  • Cognitive Behavioral Therapy (CBT) – an effective treatment that involves making changes in both the patterns of negative thoughts and the behavioral routines which are affecting the daily life of the depressed person for various forms of depression.
  • Person Centered Therapy – a strategy that allows and encourages clients to understand and resolve their concerns in a safe, support environment.
  • Solution Focused Therapy – an approach interested in solutions which can be quickly implemented with a simple first step leading to further positive consequences.

Dual Diagnosis Treatment

Alcoholism and mental health disorders often co-occur. In many cases, traumatic experiences can result in a mental health disorder and substance abuse. Dual diagnosis rehabilitation treats both of these issues together. The best approach for the treatment of dual diagnosis is an integrated system. In this strategy, both the substance abuse problem and the mental disorder are treated simultaneously. Regardless of which diagnosis (mental health or substance abuse problem) came first, long-term recovery will depend largely on the treatment for both disorders done by the same team or provider.

Medication-Assisted Treatments

Medication-Assisted Treatments (MAT) for alcohol use disorder and mental health disorder are commonly used in conjunction with one another. This includes the use of medications and other medical procedures. During your rehab, the staff from your treatment facility will help you identify what caused your addiction and teach you skills that will help you change your behavior patterns and challenge the negative thoughts that led to your addiction. Sometimes, the pressures and problems in your life lead you to rely on substances to help you forget about them momentarily.

If you or a loved one are struggling with long-term substance abuse and Trazodone side effects along with other co-occurring mental health conditions such as depression, contact one of our helpful treatment specialists today. We Level Up NJ can provide information on dual diagnosis and detox programs.

Trazodone Side Effects
Therapists who specialize in substance use can help clients identify the underlying causes of substance abuse. 

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Sources:

[1] NIH – https://medlineplus.gov/druginfo/meds/a681038.html

[2] – NCBI – https://www.ncbi.nlm.nih.gov/books/NBK470560/