The antidepressant trazodone is a serotonin modulator. It acts as an antagonist and reuptake inhibitor for serotonin. Trazodone is sold under numerous brand names, including Oleptro and Desyrel.
It is primarily used for the treatment of depression and anxiety, and as a sleep aid, although it has various off-label uses, such as to treat fibromyalgia. Trazodone has very potent sedating effects, and its use to induce sleep in individuals with mental health disorder, such as depression, anxiety disorders, etc., is one of its major medicinal uses. Its side effect profile is considerably different from other types of antidepressant medications.
Side Effects of Trazodone
According to the Food and Drug Administration (FDA), the major side effects associated with trazodone include:
- Nausea, vomiting, constipation, and/or diarrhea
- Headache, dizziness, and feeling unsteady while standing or walking
- Dry mouth
- Weakness or tiredness
- Numbness or tingling
- Tired or red eyes
- Ringing in the ears
- Burning sensations
- Muscle pain
- Uncontrollable shaking or tremors
- Decreased coordination
- Increased nervousness
- Difficulty concentrating
- Appetite changes
- Changes in sexual desire
Some of the rarer side effects that should receive immediate medical attention include:
- Accelerated, pounding, or irregular heartbeat
- Chest pain
- Shortness of breath
- Bleeding or unusual bruising
- Fainting spells
- Painful, long erections in males
- A loss of consciousness
- Increased feelings of suicide, particularly in children and adolescents using the drug
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Antidepressant medications like trazodone are not considered to be significant drugs of abuse in the same way that other drugs for psychiatric/psychological disorders, such as benzodiazepines, barbiturates, or prescription pain medications, are considered to be drugs of abuse. Trazodone is not considered to be a controlled substance by the United States Drug Enforcement Administration (DEA), but it does require a prescription. Most of the medical profession denied that there was any abuse potential for antidepressant medications for decades.
The American Psychiatric Association (APA) considers the abuse of drugs to be use that occurs outside of the boundaries of medicinal use, and trazodone is not a drug that produces significant psychoactive effects. Nonetheless, in recent years, it has been recognized that antidepressant drugs can be abused (like most any drug) and that continued use of antidepressant drugs produces a mild syndrome of physical dependence.
Abuse of Antidepressant Medications
The recognition that antidepressant drugs might have abuse potential was fostered by anecdotal reports and case studies reported in journals such as Mayo Clinic Proceedings and Psychopharmacology. The study in Mayo Clinic Proceedings documented a case of Prozac abuse with co-occurring trazodone use, and the study in Psychopharmacology used reports of former drug abusers to rate the abuse potential of various drugs, including trazodone. Both of these studies found that trazodone had a low potential for abuse, especially compared to sedative drugs like Ambien that are also used to induce sleep, but the abuse of trazodone could potentially occur.
Nonetheless, there are no formal figures regarding the abuse of trazodone by major organizations that document abuse of drugs, such as the Substance Abuse and Mental Health Services Administration (SAMHSA), and in recent research studies, such as a study published in 2014 in the journal Substance Abuse and Rehabilitation that attempted to document the prevalence of abuse of antidepressant drugs. This latter research study reported that the abuse potential for trazodone was very low and that a literature search found no significant studies reporting abuse of trazodone.
Individuals who abuse drugs and alcohol will often resort to trying to abuse any type of drug, particularly drugs that have sleep-inducing or sedating effects. Typically, these individuals will take the drug in large amounts, combine it with other drugs like alcohol, or even grind up the pills and snort or inject them with other substances.
According to NIDA, people who abuse prescription medications such as antidepressants like trazodone often:
- Do not use the medication for medicinal purposes under the supervision of a physician
- Use the medication as a secondary drug of abuse that is combined with other, more potent drugs of abuse
- Have a history of substance abuse with other drugs, including various prescription drugs and illicit drugs
- Have some co-occurring mental health disorder
Signs of Abuse
Although trazodone is not considered to be a major drug of abuse, like all medications, there is a potential that the drug can be abused. Some of the signs that would indicate that individuals are abusing trazodone include:
- Frequent use of trazodone without a prescription for the drug
- Frequently using trazodone in conjunction with other drugs of abuse, such as alcohol, benzodiazepines, narcotic pain medications, cannabis products, illicit substances like heroin, etc.
- Engaging in “doctor shopping” to get additional prescriptions for trazodone
- Using trazodone in a manner that is inconsistent with its medicinal use, such as grinding up pills and snorting them or mixing them with liquid and injecting the resulting substance
Antidepressant Discontinuation Syndrome
In recent years, it has been recognized that continued use of many antidepressant drugs like trazodone can result in a mild potential for the development of physical dependence. Typically, individuals must use the drug for more than six weeks and use it on a regular basis before any form of physical dependence occurs (the development of both tolerance and withdrawal syndromes). The majority of individuals using these drugs do not develop significant issues with withdrawal, but the syndrome does exist.
The physical dependence that occurs in relation to antidepressant drugs has been given a special label, antidepressant discontinuation syndrome (ADS), as a means to identify it is a special case of physical dependence that is separate from physical dependence that occurs with other drugs. Many medical sources still refuse to acknowledge that this is an actual syndrome of physical dependence because it is relatively mild.
Essentially, ADS represents the development of mild physical dependence as a result of using antidepressants. The symptoms of ADS include:
- Mood swings, including rebound depression (the reappearance of depressive symptoms that were present when the individual started using the medication) or issues with anxiety
- Numerous somatic symptoms, including mild headache, fatigue, dizziness, insomnia, and mild flulike symptoms (e.g., nausea, sweating, low-grade fever, and muscle aches)
- Very vivid dreams or distressing nightmares
- In rare cases, hallucinations
The duration of ADS is most often relatively short and ranges from a few days to weeks in reports. The median length of time for the duration of ADS is about eight days.
The symptom profile associated with ADS to be is reputed to be very mild in the majority of cases. It is more likely to occur with antidepressant medications such as trazodone that directly affected the release and reuptake of the neurotransmitter serotonin.
The most common strategy used to treat ADS is to slowly wean the individual off the drug by having them take increasingly lower doses at specific intervals. ADS is not considered to be potentially dangerous; however, individuals who are emotionally unstable may be at risk for self-harm or accidents due to poor judgment if they experience issues with anxiety, depression, somatic symptoms, etc. Thus, anyone who is using trazodone or any other antidepressant for medicinal reasons should not abruptly discontinue the drug unless instructed to do so by their physician. Anyone using trazodone should only use it under the supervision of a physician and should only discontinue it under the supervision of a physician.
Treatment for Trazadone Abuse
Treatment for any form of substance abuse will include the following components:
- An initial assessment of the individual’s physical, psychological, and social functioning to identify areas of need.
- A physician-assisted withdrawal management program (medical detox), if appropriate
- Education regarding the nature of substance abuse and substance use disorders
- A holistic treatment approach that addresses all of the individual’s needs, including both medically assisted treatments, such as medications, and behavioral interventions
- Treatment of any co-occurring mental health disorders, including depression, anxiety, eating disorders, trauma, etc.
- Psychotherapy for substance abuse as the cornerstone of the substance use disorder recovery program
- Social support groups
- Periodic checkups with therapists and other treatment providers to ensure the individual is maintaining abstinence
Although trazodone has a low potential for abuse, it is most often a secondary drug of abuse, often used in conjunction with some other drug, such as narcotic pain medications, benzodiazepines, etc., that requires significant and lengthy interventions.
There is a strong relationship between success in recovery and the time spent in treatment-related activities, such that individuals who remain in treatment for lengthy periods of time experience greater success in recovery. Participation in treatment-related activities, such as social support groups, should continue for years following the individual’s discontinuation of their drug of choice.