Trazodone (Desyrel)

What trazodone is

Trazodone is a medication sold under the brand name Desyrel. It works mainly on serotonin, one of the chemical messengers nerve cells use to communicate, and it has a strong calming, or sedating, effect. That sedating quality is why, although it was first used for depression, it is now very commonly prescribed in low doses to help with sleep.

What it treats

Your clinician might suggest trazodone for one of these, among other possible off-label uses:

• Trouble with sleep, one of the most common reasons it is prescribed, usually at a low dose
• Depression, usually at higher doses

Whether it is a good fit depends on several factors, including your history and what you are working on. As with everything in psychiatry, that is decided case by case.

How it works

Honestly, no one knows with complete certainty how trazodone produces its benefit. What research supports is that it acts on serotonin, helping shape how this messenger is used between nerve cells, and that this serotonin effect is central to how it helps. Its calming effect, which is why it is so often used for sleep, comes from the way it acts on other signals in the body. The biology is only part of the picture: how much a medication helps, and how it feels, is individual. Two people on the same medication can have very different experiences.

How to take it

There is no single right way to take trazodone; it depends on you and your clinician. When it is used for sleep, it is usually taken at bedtime; it is taken with a meal or a light snack, which can reduce dizziness and ease stomach upset. The plan you and your clinician make together is the one to follow, not a number you read online. A few general points apply broadly:

• Take it the way you and your clinician agreed. Because it can make you drowsy and affect your alertness, be careful with driving or anything that needs full attention until you know how it affects you, and remember that alcohol adds to the drowsiness.
• If you miss a dose, ask your clinician or pharmacist what to do rather than doubling up.
• Try not to stop on your own. Your clinician can lower it gradually if and when that makes sense.

What to expect

This varies from person to person. When it is used for sleep, the calming effect may help fairly soon; when it is used for mood, any lift usually takes longer, commonly a few weeks and sometimes more. Some people feel groggy in the morning early on, and that tends to ease as the body adjusts. If nothing has shifted after a fair trial, that is useful information, not a dead end, and there are other options. As always, this is case by case.

Side effects

Not everyone gets side effects, and many that do happen ease over the first weeks. The lists below are possibilities, not certainties.

Possible more common side effects:

• Feeling drowsy or tired, which is also the effect that helps with sleep
• Dizziness, especially when standing up
• Dry mouth
• Headache
• Diarrhea, or changes in appetite
• A stuffy nose

If any of these stick around or bother you, they are worth raising. Send a non-urgent message through the patient portal or bring it up at your next visit; often a small change helps.

Less common, but concerning side effects that could require emergency care:

• A painful erection, or one that lasts more than a few hours. This is a medical emergency: stop the medication and get care right away, because without prompt treatment it can cause lasting harm
• A fast, pounding, or irregular heartbeat, chest pain, or fainting
• Serotonin syndrome: agitation, confusion, a racing heart, fever, heavy sweating, or stiff or twitching muscles, sometimes after another medication is added
• A seizure
• Unusual bleeding or bruising
• Feeling abnormally high, wired, or irritable, with racing thoughts and far less need for sleep than usual
• Any new or worsening thoughts of harming yourself

For any of these, use the help options at the top of this page: call 911 or go to the nearest emergency department for a medical emergency or severe reaction, or call or text 988 for a mental health crisis.

When to reach out, and where

For routine questions, side effects that can wait, or how things are going, send your clinician a message through the patient portal. These are part of your ongoing care and are answered in the normal course of a few business days, so they are best for things that are not urgent.

If something feels urgent, you do not need to wait for a reply. The help options at the top of this page are the fastest way to get care: 911 or the nearest emergency department for a medical emergency or severe reaction, or 988 any time for a mental health crisis or thoughts of self-harm.

Questions to ask your clinician

• What are you hoping trazodone will help with in my case?
• How and when will we know if it is working?
• What should I do if I notice side effects?
• How long should I give it before we reassess?
• What is the plan if this one turns out not to be the right fit?
• How will we handle stopping it, if and when we get there?