Desyrel (Trazodone) for Sleep: Effective Aid or Antagonist to Rest?

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    It’s no secret that millions of people struggle to get a good night’s rest on any given night. Whether their condition is a momentary affliction or a chronic problem, many seek the help of medication in their search for a full night’s sleep. Surprisingly, many take a popular antidepressant, trazodone, for sleep. But what is trazodone, how does it work, and is it actually effective in aiding patients in their quest for rest?

    Primary Versus Secondary Insomnia

    While several factors can create sleeping problems, so pinpointing an exact cause is never easy. The first step in any discussion surrounding sleeplessness, though, is to determine whether someone is suffering from primary or secondary insomnia. Primary insomnia refers to sleeplessness that isn’t caused by factors like chronic pain or major depressive disorder. By contrast, experts usually classify secondary insomnia as a symptom of depression, anxiety, or other mental illnesses.[1] Both forms are incredibly treatable, with several options available for effective treatment.

    What is Trazodone?

    Trazodone was initially developed as an anti-depression medication in the 1960’s; the FDA didn’t approve it until 1981 under the brand name Desyrel, though.[2] Now, most doctors usually don’t pick this drug as their first choice for an antidepressant. However, it still retains a strong clinical standing as an effective treatment for unipolar depression and anxiety in adults.[3]

    Today, its side effects are often quite mild, but it wasn’t always this way. In fact, during its development and initial commercial availability, patients commonly reported that the medication made them feel drowsy. This factor lead to its now more popular use as a sleep aid at lower doses.[4]

    But What Does It Do, Exactly?

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    Trazodone is categorized as a serotonin antagonist reuptake inhibitor, or SARI. SARI’s block neurons from reabsorbing the chemical serotonin once it’s been released into the central nervous system. This process leaves serotonin in the system for longer. In turn, this helps with issues associated with depression and anxiety.[5] Now, trazodone is reportedly less effective than drugs like Prozac for treating depression. However, the mild side effects coupled with reported drowsiness give it a leg up as both an antidepressant and a sleep aid for many patients.

    Trazodone’s Second Wind

    While the primary use of trazodone is still as an antidepressant, there’s no denying that it’s incredibly popular as a sleep aid, too. In fact, one third of people who take medication for help sleeping reported taking trazodone.

    Why is this drug so popular?

    It may be due to the fact that trazodone poses a lower habit-forming risk when compared to other popular options like Lunesta and Ambien. The U.S. federal government, in fact, classifies these two drugs as controlled substances, unlike Desyrel. This latter classification means that there is effectively no limit to how many pills a doctor can prescribe someone at one time. So, folks can buy this medication in bulk without worrying about monthly refills.

    Trazodone is also uniquely affordable among popular sleeping pills. A whole month’s worth of medication? It only costs about four dollars. This quality alone makes it an extremely attractive option for a lot of patients looking to increase the quality and quantity of their sleep.

    Another reason trazodone is popular might also be due to its safety. While perhaps not the most effective option, trazodone still exhibits fewer and less severe side effects than other popular medications like Ambien. This drug is been linked to dependency as well as contributing to parasomnias. A parasomnia is a condition in which unconscious individuals participate in activities usually relegated to waking hours, such as doing chores, engaging in sexual activity, or even driving.[6]

    How is Trazodone for Sleep Prescribed?

    A black female physician prescribing Trazodone for sleep to an older black male patient

    As previously mentioned, trazodone is FDA approved specifically as an antidepressant. In other words, the FDA has not approved it for the treatment of insomnia or other sleeping disorders. However, since the most common side effect of the medication is a relaxed, sleepy sensation, many physicians prescribe is to help their patients sleep quicker and longer.

    When used to treat sleeplessness, doctors usually prescribe a low dose of trazodone. Often they advise patients to take it about 30 minutes before bedtime in order to aid in falling asleep. Patients who have trouble staying asleep might benefit from a higher dose taken several hours before bed. This simple alteration might produce fewer interruptions to sleep cycles throughout the night.[7]

    Sounds Great! Where Do I Sign?

    Not so fast. While trazodone may treat insomnia, it is not without risks and side effects.

    Common Side Effects

    Common side effects include, but are not limited to:

    • Next-day drowsiness
    • Headaches and nausea
    • Constipation
    • Dry mouth
    • Fatigue [8,9]

    The Serious Stuff

    Experts have also linked Desyrel to some serious side effects that include:

    • An increase of suicidal thoughts and behaviors, even when taken at approved doses to treat depression, particularly in adolescents
    • Dizziness and confusion in adults
    • Abnormally low blood pressure that can trigger fainting spells, which may increase the risk of serious harm
    • Heart rhythm disorders
    • Priapism, or prolonged erections in men, which can lead to impotence if not treated properly and promptly

    While these serious side effects are rare, it’s still important to be aware of the risks associated with taking this drug.[10,11]

    Industry Bias?

    The American Academy of Sleep Medicine (AASM) advises against using antidepressants as sleep aids due to prevalence of industry-funded research. In other words, studies showing trazodone as an effective sleep aid might be skewed in favor of finding it a viable solution to sleeplessness. Additionally, there are very few long-term studies into the efficacy of trazodone specifically when used primarily as a sleep aid.[12] Even so, several studies concede that other medications are more effective in treating insomnia than trazodone, even at higher doses than is normally prescribed when treating insomnia. As a result, the American Journal of Psychiatry has urged for a more intensive look into the efficacy of trazodone as a sleep aid.[13,14]

    Are There Treatments for Insomnia Aside from Meds?

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    Have no fear. There are still ways to combat sleeplessness without medication. The first step is understanding a condition to the best of one’s knowledge. Even without talking to a doctor, there are plenty of ways to alleviate symptoms that are simple and easy to implement.

    Behavioral Changes for Primary Insomnia

    Even though it might seem counterintuitive, waking habits play a large role in the ability to get good, restful sleep at night. Prolonged exposure to screens throughout the day, especially close to bedtime, can contribute to restlessness in the twilight hours of consciousness. So, saying goodbye to social media late at night—and even using less of it during the day—may improve rest quality.

    Changes to a nightly routine may also be in order. If bedtime varies wildly from night to night, then it can be harder to achieve a good night’s sleep. Other activities performed late at night, such as eating or exercising, can also result in losing precious hours of much-needed rest.

    Certain personal habits may also require changes. For example, smokers should consider cutting back, as it may help increase sleep quality. Alcohol consumption likewise disrupts sleep cycles, making it harder to fall and stay asleep through the night. So, quitting smoking and reducing alcohol intake may help some people get a better night’s rest in addition to a host of other benefits.[15]

    Secondary Tactics for Serious Insomniacs

    For insomnia that has less to do with a daily routine—and more to do with a larger problem—there are still ways to arm the self against restless nights. Now, there are no concrete routes to treating insomnia and the underlying causes simultaneously. There are, however, avenues to explore that can absolutely benefit the quality of sleep. Cognitive behavioral therapy (CBT), for example, can help people establish daily patterns to treat symptoms and mitigate triggers for mental illness. Mental illnesses like anxiety and depression, after all, can have a negative impact on one’s ability to rest.[16]

    So, talking to a doctor about antidepressants or antipsychotic medication may help. Alleviating the severity of mood swings brought on by depression or bipolar disorder has, after all, helped many improve not just sleep, but an overall sense of well being. As stated before, though, the AASM does not recommend antidepressants as a primary treatment for insomnia due to drowsiness. Why? Because drowsiness is only a side effect of these drugs, not the intended cause of treatment.

    But What If Nothing Else Works?

    As always, patients should consult with their doctors before starting or stopping a medication, and trazodone is no exception. Although there aren’t many clinical studies on this drug, patients still consistently report that it helps them sleep easier and longer. These reports, in turn, prompt doctors to prescribe it specifically for that purpose.

    Just Be Wary of Drug Interactions

    Those who are thinking of talking to their doctor about starting this medication need to tell their doctor about any and all medications they’re taking—even non-prescription ones. Why? Because they can interact with trazodone and cause negative side effects. Some people also report allergic reactions to the medication. If a reaction occurs, someone should contact their doctor right away.

    Conclusions and Takeaways

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    At the end of the day, what works best for one person might not be what works best for others. It’s important to have an open and honest dialogue with a doctor when weighing the options for treating insomnia. It’s just as important to periodically reevaluate a treatment to make sure someone is receiving the best care they can get. Trazodone has a long and decorated history within the medical community, and the positives may very well outweigh the negatives in any particular case.

    Disclaimers: This article is for reference purposes only. It is not to replace or complement the advice of a licensed professional, nor is it intended to diagnose, treat, cure, or prevent and disease or condition. Any and all health concerns should be directed at a doctor.

    Terms

    • Primary insomnia: Sleeplessness not caused by factors like major depression disorder or chronic pain.
    • Secondary insomnia: Sleeplessness that’s a symptom of another condition, such as a mental illness.
    • Unipolar depression: Condition that features symptoms of clinical depression like severely low mood. Unipolar depression is distinct from bipolar depression, which is notable for alternating periods of mania.
    • Parasomnia: A condition where unconscious individuals perform activities they would normally only do when awake. These activities include doing household chores, performing sex acts, and driving. Severe parasomnia can be extremely dangerous for both the afflicted individual as well as others.

    References

    [6,16]Gill, L. L. (2018, December 2). Should You Take Trazodone for Insomnia? Retrieved November 12, 2019, from https://www.consumerreports.org/insomnia/trazodone-for-insomnia-should-you-take/.

    [14]Hamilton, J. L., Buysse, D. J., Buysse, RA, B., Manber, McCall, … Perlis ML. (2019, November 1). Reducing Suicidality Through Insomnia Treatment: Critical Next Steps in Suicide Prevention. Retrieved November 12, 2019, from https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19080888.

    [2,7]Hazelden Betty Ford Foundation (Ed.). (2019, August 5). Trazodone: Antidepressant, Sleeping Pill or Both? Retrieved November 12, 2019, from https://www.hazeldenbettyford.org/articles/trazodone.

    [1,13]Jaffer, K. Y., Chang, T., Vanle, B., Dang, J., Steiner, A. J., Loera, N., … Ishak, W. W. (2017, August 1). Trazodone for Insomnia: A Systematic Review. Retrieved November 12, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842888/.

    [3,8,11]NHS (Ed.). (2018, December 13). Trazodone. Retrieved November 12, 2019, from https://www.nhs.uk/medicines/trazodone/.

    [12]Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017, February 15). Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. Retrieved November 12, 2019, from http://jcsm.aasm.org/ViewAbstract.aspx?pid=30954.

    [4,5,9,10,15]American Addiction Centers (Ed.). Trazodone Vs. Ambien: Uses, Side Effects, and Comparison. (2019, August 28). Retrieved November 12, 2019, from https://americanaddictioncenters.org/trazodone-abuse/vs-ambien.

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