Trazodone Side Effects: What You Need to Know

1. What are the side effects of trazodone?
2. Serious side effects of trazodone
3. What is trazodone?
4. Trazodone warnings
5. Trazodone interactions

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Depression isn’t just feeling sad or down. This mood disorder can affect all aspects of life, including your appetite, weight, sleep, work, and relationships (NIMH, 2018). 

Although we don’t yet know exactly how depression works, we do know it has to do with the balance of certain chemicals in the brain (Chand, 2020). Prescription medications like trazodone may help by affecting the levels of these chemicals. Still, you may worry about the potential side effects of these prescription drugs. If you’re talking to your healthcare provider about trazodone, here’s what you need to know.

The most common side effects of trazodone are drowsiness, nausea, dizziness, and dry mouth (Zhang, 2014). Trazodone is generally well tolerated and may be less likely than some other antidepressants to cause insomnia, sexual side effects, and anxiety (Shin, 2020).

Clinical trials have also reported other side effects, including blurry vision, constipation, confusion, fatigue, nervousness, tremors, and weight changes (FDA, 2017).

You may be more likely to experience side effects if you’re taking certain medications with trazodone. For example, there are drugs that can impact a system in your liver called CYP3A4, which breaks down trazodone (Shin, 2020). These medications may slow down this system, resulting in a buildup of trazodone in your body. In other words: increased levels of trazodone means an increased risk of potential side effects (NIH, 2017).

While not as common, trazodone does have the potential for serious side effects.  

The drug can cause serotonin levels in the body to become too high, leading to a condition called serotonin syndrome. Normally, chemical messengers (also known as neurotransmitters) pass messages between cells in the brain. Serotonin is one type of neurotransmitter. Researchers suggest medications like trazodone help alleviate depression by maintaining high levels of serotonin in the brain. 

However, abnormally high serotonin levels can cause adverse effects ranging from mild to life-threatening (Volpi-Abadie, 2013). Symptoms of serotonin syndrome include agitation, anxiety, disorientation, flushed skin, increased heart rate, nausea, restlessness, sweating, tremor, and vomiting. Shaking is particularly common (Simon, 2020). Trazodone may also cause fainting, irregular heartbeat, chest pain, seizures, shortness of breath, or difficulty breathing (NIH, 2017). Contact a healthcare provider immediately if you experience any of these symptoms.

Because the side effects of trazodone are dose-dependent, you have a higher chance of experiencing adverse effects with higher doses (Jaffer, 2017). Communicate with your healthcare provider about how you’re feeling so they can find the right dose for you. A healthcare provider can work with you to find the lowest amount that effectively manages your depression to minimize the side effects you experience.

Serotonin syndrome: symptoms, causes, treatment

Mental health

Last updated: Jul 21, 2021

6 min read

Trazodone is a generic medication (also sold under the brand names Desyrel and Oleptro; see Important Safety Information) approved by the FDA to treat major depressive disorder (MDD) (FDA, 2017). Trazodone works by increasing the levels of available serotonin in the brain, which helps alleviate depression symptoms (NIH, 2017).

Trazodone is also used off-label (in a way not specifically approved by the FDA) to treat insomnia, especially in people with depression. Chronic insomnia is different from regular sleep problems that we all experience from time to time. This condition can cause problems sleeping for a month or more. If you’re experiencing this kind of insomnia, you may be prescribed trazodone to help get your sleep schedule back on track. Trazodone is also used off-label for agitation in people with dementia.

Trazodone carries a black box warning from the U.S. Food and Drug Administration, which states the following (FDA, 2017): certain antidepressants, including trazodone, have an increased risk of suicidal thoughts and behaviors, especially children, teenagers, and young adults. Families and caregivers should be aware of this risk, especially during the first few months of therapy or after a dose increase. They should also be on the lookout for suicidal thoughts, attempts, or completions, or other mood changes. Trazodone is not FDA-approved for use in people under 18 years of age.

Patients taking trazodone who have been diagnosed with MDD may be at risk of attempting suicide or self-harm (Coupland, 2014). A healthcare provider can work with you and your family to monitor the severity of your depression symptoms—especially when first starting the medication, or after a change in dosage.

Trazodone tends to cause less anxiety and insomnia and fewer sexual side effects than some other SSRIs and SNRIs, but that doesn’t mean it’s without side effects (Shin, 2020). The drug may also cause anxiety, agitation, panic attacks, difficulty sleeping, irritability, hostility, impulsivity, and movement disorders. If you experience any of these, tell a healthcare provider who can stop or change your medication. This is also the reason trazodone should not be prescribed for anyone with a history of bipolar disorder.  

If you suddenly stop taking trazodone, you may experience what’s called discontinuation syndrome (NIH, 2017). This is when patients who have been on an antidepressant for at least six weeks experience side effects from abruptly stopping treatment. About one in five people get discontinuation syndrome, which symptoms may include balance problems, feeling like you have the flu, nausea, and trouble sleeping. These symptoms may take up to two weeks to go away (Warner, 2006). If you wish to discontinue trazodone, work with a healthcare professional to do it gradually and safely.

Trazodone: warnings, side effects, and more

Antidepressant medications

Last updated: May 12, 2021

5 min read

Trazodone should not be taken with other medications or over-the-counter supplements that increase serotonin levels. Here are the main ones to avoid (NIH, 2017): 

• MAOIs
• Triptans 
• Tricyclic antidepressants 
• Selective serotonin reuptake inhibitors (SSRIs)
• Fentanyl
• Lithium
• St. John’s wort

Be careful taking trazodone with any blood thinners. If you need to take blood thinners while on trazodone, a healthcare provider may adjust your dose to limit bleeding risk (NIH, 2017).

Talk to a healthcare provider if you wish to drink alcohol while taking trazodone. Alcohol slows down the central nervous system, which may slow your reaction time and trazodone can enhance these effects (NIH, 2017). 

Treatment for major depressive disorder with trazodone is generally well-tolerated, but there are side effects. The most common ones are dry mouth, drowsiness, dizziness, and nausea, but more serious side effects are possible. Make sure your healthcare provider knows what other medications you’re on so they can determine whether trazodone may be a good option for you.

1. Beasley, C. M., Jr, Dornseif, B. E., Pultz, J. A., et al. (1991). Fluoxetine versus trazodone: efficacy and activating-sedating effects. The Journal of Clinical Psychiatry, 52(7), 294–299. Retrieved from https://pubmed.ncbi.nlm.nih.gov/2071559/ 
2. Chand, S. P. & Arif, H. (2020). Depression. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430847/ 
3. Coupland, C., Hill, T., Morriss, R., et al. (2015). Antidepressant use and risk of suicide and attempted suicide or self harm in people aged 20 to 64: Cohort study using a primary care database. BMJ, 350, H517. doi:10.1136/bmj.h517. Retrieved from https://www.bmj.com/content/350/bmj.h517 
4. Jaffer, K.Y., Chang, T., Vanle, B., et al. (2017) Trazodone for Insomnia: A Systematic Review. Innovations in Clinical Neuroscience, 14(7-8), 24-34. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842888/ 
5. National Institutes of Health (NIH). (2017). Trazodone: MedlinePlus Drug Information. Retrieved Nov. 13, 2020 from https://medlineplus.gov/druginfo/meds/a681038.html 
6. National Institute of Mental Health (NIMH). (2018). Depression. Retrieved Nov. 13, 2020 from https://www.nimh.nih.gov/health/topics/depression
7. Rotzinger, S., Fang, J., & Baker, G. B. (1998). Trazodone is metabolized to m-chlorophenylpiperazine by CYP3A4 from human sources. Drug metabolism and Disposition, 26(6), 572–575. Retrieved from https://pubmed.ncbi.nlm.nih.gov/9616194/ 
8. Shin, J. J. & Saadabadi, A. (2020). Trazodone. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470560/ 
9. Simon, L. V. & Keenaghan, M. (2020). Serotonin Syndrome. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482377/ 
10. Terao, T. (1993). Comparison of manic switch onset during fluoxetine and trazodone treatment. Biological Psychiatry, 33(6), 477-478. doi:10.1016/0006-3223(93)90176-e. Retrieved from https://psycnet.apa.org/record/1993-42495-001 
11. Thompson, J. W., Jr, Ware, M. R., & Blashfield, R. K. (1990). Psychotropic medication and priapism: a comprehensive review. The Journal of Clinical Psychiatry, 51(10), 430–433. Retrieved from https://pubmed.ncbi.nlm.nih.gov/2211542/ 
12. United States Food and Drug Administration (FDA). (2017). Desyrel Label. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018207s032lbl.pdf 
13. Volpi-Abadie, J., Kaye, A. M., & Kaye, A. D. (2013). Serotonin syndrome. The Ochsner Journal, 13(4), 533–540. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865832/ 
14. Warner, C. H., Bobo, W., Warner, C., et al. (2006). Antidepressant discontinuation syndrome. American family physician, 74(3), 449–456. Retrieved from https://www.aafp.org/pubs/afp/issues/2006/0801/p449.html
15. Zhang, L., Xie, W., Li, L., et al. (2014). Efficacy and Safety of Prolonged-Release Trazodone in Major Depressive Disorder: A Multicenter, Randomized, Double-Blind, Flexible-Dose Trial. Pharmacology, 94(5-6), 199-206. doi:10.1159/000368559. Retrieved from https://www.karger.com/Article/Abstract/368559#

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.

Trazodone: Side Effects, Withdrawal, & Treatment

Causes of Depression

Sometimes, it is used as an off-label treatment for other conditions, such as insomnia, schizophrenia, and anxiety.

Trazodone belongs to a class of medications called serotonin modulators, which means they work by altering the activity of post-synaptic serotonin receptors and by inhibiting the reuptake of serotonin.

While trazodone is not considered a highly addictive prescription medication, it still has a potential for misuse and dependence.

Individuals who abuse trazodone or who are prescribed it should be aware of its effects and seek professional advice.

What Is Trazodone Mainly Used For?

Trazodone is mainly used to treat depression.

However, it is also sometimes used to treat anxiety, insomnia, and schizophrenia.

What Is The Brand Name For Trazodone?

Brand names for trazodone include:

• Desyrel
• Oleptro
• Trialodine

Is Trazodone Addictive For People?

Trazodone is not considered highly addictive, yet there is still potential for misuse and dependence.

A study done by Psychopharmacology discussed the abuse potential for three different drugs, including trazodone, Ambien, and Halcion.

Findings suggest that trazodone is less addictive than the other two drugs in the study, yet it is still misused and can cause physical dependence, especially when used for a long period.

According to Substance Abuse and Rehabilitation, most cases of antidepressant abuse occur in individuals with other substance use and mood disorders.

What Class Of Drug Is Trazodone?

Trazodone is a serotonin modulator, or in the serotonin-antagonist-and-reuptake-inhibitor (SARI) class of medications.

Serotonin is a neurotransmitter that plays an important function in mood stabilization. When a person’s serotonin levels are low, it can contribute to depression and other mental health disorders.

Serotonin modulators, like trazodone, work by targeting certain serotonin receptors, including the 5-HT2A receptor.

What Does Trazodone Look Like?

Trazodone is usually white and round or oval-shaped.

It also has scores imprinted on the sides that may be used to break the tablet in half to split the medication into two doses if recommended by your doctor.

Trazodone Uses

How Do You Take Trazodone?

Trazodone comes as a tablet that should be taken by mouth.

It is usually recommended to take trazodone with a meal or snack two or more times a day.

The tablets are either taken whole or broken in half where indented and taken.

If prescribed, it is important to follow your doctor’s orders carefully, along with any directions on your prescription label. A person should not take more or less than what is prescribed without consulting with their doctor.

How Does Trazodone Make You Feel?

Most people who have been prescribed trazodone report feelings of relaxation and sleepiness.

It can also help people improve their mood and manage the symptoms of depression.

Some people may abuse trazodone for its sedative effects and to achieve a “high.” While it may not produce a sense of euphoria similar to other drugs like marijuana, it can make a person feel extremely relaxed and drowsy, and some people find pleasure in it.

Additionally, when first taking trazodone, a person may feel that their symptoms of depression or anxiety are worsening.

This can be because the body is adjusting to new chemical levels and changes. However, it is important to let your doctor know if you are experiencing adverse side effects.

Is Trazodone Habit-Forming?

Trazodone is not known to be habit-forming. However, it should only be taken as prescribed to avoid misuse and potentially dangerous adverse effects.

Is Trazodone Good To Take Every Night?

It is not uncommon for trazodone to be prescribed daily and to be taken in the evening.

However, if a person is misusing trazodone, taking it every night can be extremely harmful, increase the risk of overdose, and have serious negative effects on their physical and mental health.

How Long Does It Take For Trazodone To Work?

It can take a couple of weeks for trazodone to start to work and for a person to see improvements.

It can take the body time to adjust to the medication. For some people, trazodone can take up to 6 weeks to work.

Can You Take Trazodone For Sleep And Anxiety?

Trazodone is sometimes used as an off-label treatment for sleep and anxiety.

Who Should Avoid Trazodone?

It is always important to let your healthcare provider know any current medications or supplements you are taking, along with any medical history or conditions you may have before starting trazodone.

If you are planning to become pregnant, are pregnant, or are breastfeeding, consult with your healthcare provider about the safety of taking trazodone.

Trazodone also contains a boxed warning of an increased risk of suicidal thoughts and behaviors in pediatric patients.

It should also be used carefully with elderly individuals as it may increase the risk of hyponatremia, which refers to a low sodium level in the blood.

Additionally, individuals with kidney failure or liver failure should use trazodone with caution and talk to their doctors about risks and safety.

Trazodone Dosage & Interactions

What Is The Typical Dosage Of Trazodone?

When used for depression, the typical dosage of trazodone is 150 mg.

Dosages for trazodone can range from a low dose of 50 mg to 600 mg for hospitalized patients.

Dosages typically start at 150 mg and may be increased in 50 mg increments depending on the individual’s response to the medication.

How Often Should You Take Trazodone?

Trazodone is usually taken as a single dose per day.

Sometimes, a doctor may recommend a person split it in half and take it twice a day.

You should only take trazodone as it is prescribed to you, no more and no less, and if you plan on making any changes to your medication or plan on stopping use, consult with your doctor first.

Is 50mg Of Trazodone A Lot?

50 mg of trazodone is not considered a lot; it is usually the starting dose.

Trazodone is available in 25 mg, 50 mg, 100 mg, and 300 mg oral tablets.

However, taking any dose of a medication when it is not prescribed can be very dangerous and result in harm to both the brain and body.

Can Trazodone Be Mixed With Alcohol?

Alcohol can worsen the effects of trazodone, and mixing the two can become dangerous.

Mixing alcohol with antidepressants like trazodone can not only make a person extremely drowsy but also make a person feel more depressed or anxious.

Individuals who misuse trazodone often do so by combining it with other substances. Mixing substances like trazodone and alcohol can increase a person’s risk of overdose and result in serious consequences.

Are There Interactions Between Lexapro And Trazodone?

Lexapro, or escitalopram, is another antidepressant medication used to treat depression and generalized anxiety disorder.

Taking escitalopram together with trazodone is usually not advised as it may cause adverse side effects and put a person at higher risk of serotonin syndrome.

It is important to let your doctor know if you are already taking Lexapro or any other antidepressants so that you can reduce the risk of negative and potentially dangerous side effects.

What Should You Not Take With Trazodone?

It is important to let your doctor know of any prescription medications and non-prescription medications you are taking, including vitamins and herbal supplements, before starting trazodone.

Herbal products and nutritional supplements that are especially important to mention include St. John’s Wort and tryptophan.

You should let your healthcare provider know if you are taking monoamine oxidase inhibitors (MAOIs) like tranylcypromine or isocarboxazid, as your doctor may typically recommend not taking the medications together.

Taking MAO inhibitors and trazodone together can greatly affect a person’s serotonin levels and cause a spike in a person’s blood pressure.

Important medications to mention include:

• Blood thinners
• Medications for mental illness
• Selective serotonin reuptake inhibitors
• Tricyclic antidepressants
• Antifungals
• Medications for migraines

A person should also take caution before driving if taking trazodone, as its effects can cause impairment. Don’t drive or operate machinery until you know how this medication affects you and after consulting with a doctor.

Trazodone Side Effects

What Are The Side Effects Of Trazodone?

Side effects of trazodone can include:

• Blurred vision
• Nausea and vomiting
• Diarrhea or constipation
• Changes in appetite
• Weight changes
• Feeling weak or tired
• Nervousness
• Dizziness
• Lightheadedness
• Nightmares
• Muscle pain
• Dry mouth
• Rash
• Stuffy nose
• Red or itchy eyes

Serious side effects of trazodone can include:

• Chest pain
• Changes in heartbeat
• Loss of consciousness
• Fainting
• Fever
• Shortness of breath
• Unusual bleeding or bruising
• Headaches
• Problems thinking or concentration
• Trouble with memory
• Lack of coordination

Antidepressants like trazodone can also increase the risk of a person experiencing suicidal thoughts, especially in adolescents, children, and young adults.

In rare cases, trazodone use can cause serotonin syndrome, a potentially life-threatening condition where a person’s serotonin levels are too high, causing them to experience both mental and physical symptoms.

If you or a loved one are experiencing suicidal thoughts, seek help. Call 911 or the national suicide prevention lifeline at 988. You are not alone, and there is help for you.

Trazodone may also cause a condition called angle-closure glaucoma, where the fluid in the eye causes a severe increase in pressure and can lead to vision loss.

Any individual who uses antidepressants for longer than 8 weeks faces the risk of developing a physical dependence on the drug, meaning that they can face withdrawal symptoms if they suddenly stop using the drug or significantly decrease their use.

What Is The Most Likely Side Effect Of Trazodone?

The most common side effects of trazodone include drowsiness, dizziness, and nausea.

Can Trazodone Worsen Anxiety?

When a person first starts trazodone, they may feel that their depression or anxiety is worse because their body is adjusting to the new change.

Usually, in this case, the person tends to feel better after the first few weeks.

However, adverse effects of trazodone can include anxiety or depression.

Does Trazodone Cause Weight Gain?

Yes, trazodone can cause both changes in appetite and weight.

It can make a person more hungry and cause them to eat more and gain weight.

Is Trazodone Hard On Your Heart?

Trazodone could negatively affect a person’s heart.

It can cause a condition known as QT prolongation, which can involve a fast or irregular heartbeat and other potentially serious symptoms.

However, according to Psychopathology, trazodone has been shown to have little effect on cardiac conduction and had shown to produce less postural hypotension than other antidepressants and actually lowers heart rate.

Additionally, trazodone is not usually recommended for those who have suffered a heart attack at any point in their life.

Does Trazodone Affect Your Thinking?

Trazodone may affect a person’s thinking, concentration, and memory, according to MedlinePlus.

Is Trazodone Harmful Long-term?

Trazodone is commonly taken as a long-term medication.

When used as prescribed, trazodone is considered generally safe. However, when misused, trazodone can harm both the brain and body.

Any person who takes antidepressants long-term, whether prescribed or not, has a risk of developing physical dependence.

In this case, the person should seek help from their doctor so they can safely manage their symptoms and reduce the risk of serious effects.

Trazodone Withdrawal & Treatment

What Mental Illness Does Trazodone Treat?

Trazodone is mostly used to treat depression, specifically major depressive disorder.

Trazodone is also sometimes used as an off-label treatment for anxiety.

Does Trazodone Deplete Dopamine?

Trazodone reduces levels of certain neurotransmitters that are associated with arousal effects, including serotonin, noradrenaline, dopamine, acetylcholine, and histamine.

Can Trazodone Be Stopped Abruptly?

No, trazodone should not be stopped abruptly.

Doing so can trigger withdrawal symptoms and become very dangerous.

Withdrawal symptoms of trazodone can include:

• Dizziness
• Nausea and vomiting
• Irritability
• Headaches
• Trouble concentrating

It is important to always let your healthcare provider know if you plan on stopping taking medication so that they can provide you with safety, advice, and supervision if needed.

Trazodone should be tapered, meaning the daily dose should slowly decrease with the end goal of completely discontinuing the medication to reduce the risk of withdrawal symptoms.

Sandstone Care’s Detox program helps with withdrawal symptoms

How Long Does It Take Trazodone To Wear Off?

Trazodone has a half-life of around 5 to 9 hours.

This means that it can take 5 to 9 hours for your body to eliminate half of the drug.

Can You Get Withdrawal Symptoms From Stopping Trazodone?

Yes, a person may experience withdrawal symptoms from stopping trazodone which may include:

• Anxiety
• Insomnia
• Fatigue
• Flu-like symptoms
• Suicidal thoughts

If you or a loved one are experiencing suicidal thoughts, call 911 or the national suicide prevention lifeline at 988.

If you are experiencing withdrawal symptoms, seek medical help and call your doctor so they can give you professional guidance to help you safely manage withdrawal symptoms.

Take the Quiz

See if you or a loved one needs substance use or mental health support

Developed by Chief Clinical Officer Sarah Fletcher LPC

Take the Quiz

Can Trazodone Cause Permanent Damage?

Trazodone can lead to long-term and, in some cases, permanent damage.

For example, a person taking trazodone can develop a condition known as priapism, with is an abnormal erection that can lead to permanent damage.

Aside from being used to treat depression, trazodone is also used to treat insomnia, schizophrenia, and anxiety.

However, when used for reasons other than depression, it is not FDA-approved.

It is not considered a first-line treatment for insomnia, although it can be effective in helping sleep.

The link between trazodone use and psychosis is unknown. However, there have been reports of visual hallucinations as an adverse effect of trazodone.

A visual hallucination involves seeing things that aren’t real, which may include objects, lights, shapes, or people.

Brain zaps can feel like a sudden shock in the head which is caused by anxiety, stress, or medications.

Brain zaps can happen when a person stops or decreases their use of medication, especially antidepressants.

Brain zaps may result as a symptom of withdrawal when stopping antidepressants like trazodone.

Trazodone is not known to be addictive.

However, treating sleep disorders like insomnia with trazodone is off-label use that is not approved by the FDA.

Valium, also known as diazepam, is a benzodiazepine used to treat anxiety, muscle spasms, and seizures.

Some people who have been prescribed Valium for sleep and do not see results may sometimes be prescribed trazodone as an alternative.

Trazodone is more commonly used as a treatment for depression and anxiety, while Valium is typically used for anxiety, alcohol withdrawal, and seizures.

While it doesn’t necessarily change your personality, trazodone may cause changes that affect a person’s mood and behaviors.

Adverse effects of trazodone use involve problems with thinking, concentration, and memory.

Some studies have examined the relationship between trazodone use and the development of dementia. However, it appears that more research is needed to determine whether the two are connected.

Let’s take the next steps together

Trazodone is an antidepressant used to treat depressive disorders. Trazodone has the potential to be misused and may come with serious negative effects. Sandstone Care is here to support teens and young adults with mental health and substance use disorders.

Call (888) 850-1890Verify Insurance

Trazodone (Trittico)

Trazodone is an antidepressant , belongs to the class of SSRIs, has a sedative effect, is used in the treatment of depression

Analogues (generics, synonyms) 90 010

• Trittiko;
• Azona;
• Beneficiary.

Available by prescription, listed in the regular reporting register . Active ingredient: Trazodonum

Prescription form 107-1/y
Latin prescription:
Rp. :Trazodoni 0.1
D.t.d. No. 25 in caps.
S.: Inside, 1 caps. 1 time per day before bed.

Presentation
Long-acting tablets, white or white with a yellowish tint, oval, biconvex, with two parallel notches on both sides.

1 tab. trazodone hydrochloride 150 mg.
Excipients: sucrose – 84 mg, carnauba wax – 24 mg, povidone – 24 mg, magnesium stearate – 6 mg.

10 pcs. – blisters (2) – packs of cardboard.
10 pcs. – blisters (6) – packs of cardboard.

Mechanism of action
SARI antidepressant is a serotonin reuptake inhibitor and 5HT2 receptor antagonist.

Therapeutic indications
Major depressive episodes. Mixed states of depression and anxiety, with or without secondary insomnia.

Directions for use
Orally, swallowed whole, with or without food, with plenty of liquid. The dosage is adjusted by the doctor depending on the disease. The initial daily dose is 150-300 mg divided into 3 doses. Maximum up to 600 mg/day.

Contraindications
Hypersensitivity. Poisoning by alcohol or sleeping pills. Acute myocardial infarction.

Warnings and Precautions
Children <18 years of age, increased risk of suicidal behavior and insufficient safety data. Careful observation, especially in the initial stages and when changing the dose, the risk of suicide / suicidal thoughts. Schizophrenia or other psychotic disorders, risk of worsening psychotic symptoms. Known cardiovascular disorders, including QT interval prolongation. Concomitantly with substances that prolong the QT interval, such as: class IA and III antiarrhythmic drugs, antipsychotics (phenothiazine derivatives, pimozide, haloperidol), tricyclic antidepressants, certain antimicrobials (sparfloxacin, moxifloxacin, erythromycin IV, pentamidine, antimalarial treatment, especially halofantrine) , astemizole, mizolastin. Periodic control in: irresistible. heart failure, angina, conduction disturbances or AV block of varying degrees, arrhythmias, recent myocardial infarction, p. congenital long QT interval or bradycardia, epilepsy (avoid sudden increase or decrease in dose), intraocular or intraocular injections, hyperthyroidism, prostatic hypertrophy, acute angle-closure glaucoma, increased intraocular pressure. The elderly are more sensitive to anticholinergic effects. With long-term treatment, gradually reduce the dose to avoid withdrawal symptoms. Suppress that one. when jaundice occurs. The risk of developing serotonergic s. / malignant neuroleptic p.

Liver failure
Caution in severe liver disease, consider periodic monitoring of liver function.

Renal failure
Caution in severe disease.

Interactions
Increases the sedative effect of: alcohol, antipsychotics, hypnotics, sedatives, anxiolytics and antihistamines.
The effect is enhanced by: erythromycin, ketoconazole, itraconazole, ritonavir, indinavir and nefazodone.
The effect is reduced by: carbamazepine.
Enhances the action of: muscle relaxants, volatile anesthetics.
Risk of developing serotonin syndrome when taking tricyclic antidepressants.
Increased risk of St. John’s wort toxicity.

Pregnancy
There are limited data (<200 term pregnancies) on the use of trazodone in pregnant women. Animal studies do not indicate direct or indirect harmful effects on pregnancy, embryonic/intrauterine development, childbirth or postpartum development at therapeutic doses. As a precautionary measure, it is preferable to avoid the use of trazodone during pregnancy. Appointment to pregnant women should be administered with caution. When using trazodone before delivery, newborns should be monitored for the occurrence of withdrawal syndromes.
Epidemiological evidence suggests that the use of SSRIs during pregnancy, especially in advanced pregnancy, may increase the risk of persistent pulmonary hypertension in the newborn (PPNH). The observed risk was approximately 5 per 1000 pregnancies. In the general population, there are 1 or 2 cases of EUI for every 1000 births.
Although there are no studies investigating an association with trazodone treatment, this potential risk cannot be excluded.

Breast-feeding
It is not known if trazodone and its metabolites are excreted in breast milk. A risk to the infant should not be excluded. The decision to continue/discontinue breastfeeding or continue/discontinue trazodone therapy should be made taking into account the benefits of breastfeeding for the baby and the benefits of trazodone treatment for the mother.

Effects on ability to drive
May cause sedation, dizziness. Therefore, patients should be made clear that if they experience sedation or dizziness, they should avoid potentially hazardous tasks such as driving or operating machinery.

Adverse reactions
Frequency unknown: blood dyscrasias. Allergic reactions. Syndrome of insufficient secretion of antidiuretic hormone. Hyponatremia, weight loss, anorexia, increased appetite. Suicidal behavior or suicidal thoughts, confusion, insomnia, disorientation, mania, restlessness, nervousness, agitation, frustration, aggressive reaction, hallucinations, nightmares, decreased libido, withdrawal symptoms. Serotonin syndrome, convulsions, neuroleptic malignant syndrome, dizziness, dizziness, headache, drowsiness, agitation, decreased mental acuity, tremor, blurred vision, memory impairment, myoclonus, expressive aphasia, paresthesia, dystonia, taste disturbance. Cardiac arrhythmias, bradycardia, tachycardia, ECG abnormalities. Orthostatic hypotension, hypertension, syncope. Nasal congestion, shortness of breath. Nausea, vomiting, dry mouth, constipation, diarrhea, dyspepsia, abdominal pain, gastroenteritis, increased salivation, colon paralysis. Liver dysfunction, intrahepatic cholestasis. Skin rash, itching, hyperhidrosis. Pain in the extremities, back pain, myalgia, arthralgia. Urination disorder. Priapism. Weakness, swelling, flu-like symptoms, fatigue, chest pain, fever.

8 (499) 398 – 20 – 68 8 (925) 822 – 88 – 61

Request a call back

9 0000 how to take drugs, the effect, can you drink without a prescription and with alcohol

Medicine and health

06/07/23

Ekaterina Kushnir

treats anxiety disorder

I have generalized anxiety disorder.

For a long time I coped without pills and other help, but one day I got tired of constant anxiety and began to interfere with my normal life. As a result, I turned to a private psychiatrist.

The doctor prescribed an antidepressant from the SSRI group – these are selective serotonin reuptake inhibitors. Such drugs are the first thing prescribed in the treatment of depression and a number of other conditions, including my disease.

The doctor immediately warned me about some peculiarities associated with taking the drug. Some of them I then felt on myself. I think everyone who plans to be treated with antidepressants should know about them.

At the same time, it should be taken into account that most of the negative effects of therapy are temporary and not dangerous, and if they do not go away, one medicine can be replaced with another. Antidepressants help many people with mental disorders and other illnesses get rid of their symptoms and return to a full life, so you definitely should not be afraid of them. The main thing is to take such drugs when they are really needed: as prescribed by a competent doctor and under his control.

See a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don’t write prescriptions, we make recommendations. Relying on our point of view or not is up to you.

Fact No. 1

Antidepressants may make symptoms worse at first

Antidepressants can increase anxiety in anxiety disorders, as well as cause irritability and agitation – the so-called causeless motor agitation, the inability to sit still. It’s not dangerous, but rather unpleasant. This condition is sometimes referred to as initial anxiety, that is, the anxiety of starting therapy. Up to 65% of people face it.

Antidepressant-induced anxiety syndrome – a systematic review in the British Journal of Psychiatry

There is also evidence that some classes of antidepressants, including SSRIs, may increase suicidal ideation in depression in young people aged 18 to 24 years. These data are not very reliable, and in older people, the risk of suicide no longer increases and even decreases.

Without treatment, depression is more likely to lead to suicidal thoughts, and in case of anxiety, you just need to prepare for such an effect, then it will be easier to survive the attacks.

The doctor told me that in the first two or three weeks there may be an increase in anxiety, but I did not take it too seriously.

Everything was fine for the first week. After about seven days, I became nervous and irritable. And then I woke up at night and after a while I felt an incomprehensible fear. My heartbeat increased, my head was spinning, my throat was constricted. Because of this, I felt a real panic – I spent the rest of the night fighting terrible thoughts, in the morning I got up completely broken.

8 myths about antidepressants

I never had such panic attacks before taking medication — my anxiety was background, general. I got scared and wrote to the doctor, who reassured me and said that it was not dangerous and would pass soon.

After that, I already expected these panic attacks, immediately tried to relax, calm down, remember that this was just a temporary effect of the drugs. And they ended faster, and then they completely disappeared.

My letter to a psychiatrist. I was scared: I expected an increase in background anxiety, but not panic attacks. I even thought about giving up the medicine

Fact No. 2

The effect of antidepressant treatment will not be immediate

Increase the dose of antidepressants gradually to reduce side effects. They usually start with the minimum, and then bring it up to the working one. For example, for SSRIs with the active ingredient “sertraline”, the working dose is from 100 mg per day. I started taking such a drug with 25 mg, and then gradually, in several steps, under the supervision of a doctor, raised the dose to 100 mg.

SSRI dosage – NHS

What doses of antidepressants will be optimal – an article in The Lancet

The process of reaching a working dose can take from two weeks to a month or more. It depends on the drug and its tolerance. I turned out to be sensitive to the medicine, it was hard for me to survive every increase in dosage: anxiety increased again, there were other side effects that then stopped. However, this is not the case for everyone, sometimes the process goes faster.

The full therapeutic effect, that is, the disappearance or a strong improvement in the symptoms of the disease, occurs some time after reaching the working dosage. As a rule, this is a week or two, although some positive changes may be earlier. For some people, this process stretches for a longer period: 6-12 weeks. Minimum initial doses of drugs usually do not work.

It is better to prepare right away for the fact that the symptoms of the disease will not disappear in the first weeks of treatment. And remember – this does not always mean that the drug needs to be changed, sometimes you just need to wait or further increase the dosage under the supervision of a doctor.

Fact No. 3

Antidepressants are usually taken in combination with other drugs

Another way to mitigate the side effects of antidepressants is to prescribe an additional drug along with them: for example, from the group of tranquilizers. Such drugs may have their own side effects, they should not be taken for a long time. Unlike antidepressants, some of them can be addictive. They are usually appointed for a month, but this period may be shorter or longer.

Antidepressants together with benzodiazepines work better for depression – BMJ magazine

My doctor prescribed a rather mild drug for me. However, he did not suit me. At first, it caused increased drowsiness: during the period of increased anxiety, it went away for a while, but then returned – even with half a pill I turned off and could sleep all day. And if I drank at night, I woke up with difficulty in the morning. The psychiatrist prescribed another medicine, but I could not buy it: the drug was not available in any pharmacy nearby.

As a result, I simply endured all the side effects of therapy – they were unpleasant, but tolerable. When discussing with the doctor, she called this option acceptable if the side effects of the second medicine only worsen the situation.

My prescriptions for drugs. I never used one, because there was no such medicine in pharmacies

Fact No. 4

Side effects are not always, but they are

Modern antidepressants, including SSRIs, are mild and have almost no side effects. Older drugs – tricyclic antidepressants and monoamine oxidase inhibitors – cause more side effects. Doctors usually use them when milder first-line drugs don’t work or when they can’t be prescribed.

Side effects of antidepressants – NHS

Side effects of different antidepressants – UpToDate

Side effects of antidepressants and their impact on the outcome of treatment of major depressive disorder – Nature

Selective reuptake inhibitors with erotonin – UpToDate

How to deal with side effects effects of antidepressants – advice from the Mayo Clinic staff

Choosing an SSRI drug does not guarantee the absence of side effects – many people tolerate treatment easily, but sometimes a change in drug may be necessary.

For the first couple of weeks of taking it, there is a risk that you will not feel well – it is worth thinking about. It may be worth scheduling the start of therapy on vacation.

I work remotely, and it was easier for me: the first pill was taken on Saturday, I slept through the weekend. Then she continued to work, but refused any additional loads: housework, part-time jobs, training and everything else.

It was hard to work: I wanted to sleep, then I began to worry and get distracted. I also had diarrhea, nausea, headaches, tremors, i.e. hand trembling, hot flashes, sweating, palpitations. At night, panic attacks began, in the morning I had difficulty getting up because I was in pain and dizzy.

There are mixed data on how common side effects of antidepressants are. If we summarize them, then the numbers look something like this:

• nausea – about 25% feel it;
• diarrhea – it happens in 15% of people, and 5%, on the contrary, will have constipation;
• about 20% of people have sweating and feeling hot;
• sexual dysfunction, decreased libido may occur in 80% of cases;
• insomnia – in 11% of cases;
• headache and dizziness – in about 10-11% of cases;
• weight gain – not all drugs give this effect. Some, on the contrary, can reduce weight. On my medicine, I lost 2 kilograms in the first month, despite the fact that I quit training due to poor health. True, then they returned back.

It can be seen that most side effects occur in less than half of the cases. In addition, in most cases they pass in the first weeks and are not dangerous.

Side effects not listed above are very rare. I was “lucky”, and I faced one such – a decrease in visual acuity. Once in the morning I noticed that I see worse without glasses. A little later, I realized that something was wrong with the glasses.

I wrote to the doctor, she replied that this happens, as a rule, is not dangerous and passes, but it is better to visit an ophthalmologist. I went to the ophthalmologist, everything was fine with my eyes, there was nothing terrible, but my vision really worsened – it was not a subjective feeling. On the right eye, it was -0.5 diopters, it became -0.75, and on the left eye it was -1. 5, and it became -3.5.

I was offered to try changing the drug, but I decided to wait. Vision was then restored. I have not yet gone to the doctor to have it measured, but according to subjective feelings, it is at the same level as before: I am comfortable again in my glasses.

Side effects should not be tolerated – if something greatly worries, scares or interferes with life, it is better to tell the doctor right away. The psychiatrist will be able to determine whether the side effect of the drug is dangerous and whether it is worth continuing to take it. There are several antidepressants of the SSRI group, in addition, there are groups of drugs with a slightly different mechanism of action. As a rule, doctors manage to find a medicine that gives a good effect without side effects.

If there is no danger, the doctor can adjust the dose or increase it more gradually – this often helps to cope with unpleasant effects.

I wrote to the doctor again when my visual acuity decreased

Fact No. 5

Antidepressants need to be taken long term

Antidepressants are not drugs that you can stop drinking as soon as you get better. They are taken for a long time: usually from several months, less often several years.

Anxiety Therapy – UpToDate

For example, for generalized anxiety disorder, the duration of treatment is at least a year. Moreover, the date is not counted from the very beginning, but from the moment when a lasting effect appeared from the pills. In fact, they will have to be drunk for about 1.5 years – it depends on how long it takes to reach the working dosage of the medicine.

The cost of a package of the most famous antidepressant “Zoloft” is about 700 R, enough for about a month. That is, a course of therapy will cost about 10,000 R – maybe more or less, depending on which drug is selected.

Psychotherapy review – UpToDate

Another drug of the same group already costs more than 2000 R per pack. Source: rigla.ru

The cost of an appointment with a good psychiatrist in Moscow is 3000-5000 R. At first, you will need to visit him about once every 1-1.5 months, then less often.

You can apply to the psycho-neurological dispensary at the place of residence under compulsory medical insurance – it’s free. At the same time, they will not put you on psychiatric registration: it was canceled in 1993. People with disorders that do not threaten their lives or those around them are on consultative and diagnostic care. If you stop going to the doctor, he will not find out what happened: a person seeks help at will.

Psychotherapy, usually cognitive-behavioral, is also commonly prescribed to enhance and sustain the effects of antidepressants. In many cases, it improves the effectiveness of drugs, including depression and generalized anxiety disorder. An appointment with a psychotherapist in Moscow costs an average of 5000 R. For treatment, you will need about 10 sessions or more.

How psychotherapy works

Fact No. 6

Antidepressants should not be stopped abruptly

Antidepressants do not develop dependence. However, if you abruptly stop drinking them, there will be a withdrawal syndrome. This is felt as electric current discharges while moving or turning the head, headaches, dizziness, insomnia. Many people experience symptoms similar to the flu or an intestinal virus: low fever, diarrhea, general malaise, chills. Often there is anxiety, there are intrusive images.

Withdrawal symptoms after taking serotonin reuptake inhibitors – Journal of Clinical Psychiatry

How difficult it is to stop antidepressants – American Psychological Association

Stopping antidepressants in adults – UpToDate

for some reason they changed their minds about taking the pills or the term has expired treatment, they should be canceled only under the supervision of a doctor.

Antidepressant withdrawal occurs as gradually as the start of treatment. The dosage is slowly reduced, usually at this time again a cover-up drug is prescribed to alleviate side effects. As a rule, this is the same medicine that was at the beginning of the intake.

Withdrawal is usually harmless and resolves within the first weeks of stopping the drug. Sometimes even within a few days – it still depends on which medicine was prescribed. If severely disturbing symptoms appear during the withdrawal period, you should consult a doctor.

Fact No. 7

If you need to change the drug, everything will start over

It is far from always possible to immediately find the right antidepressant – sometimes the side effects do not go away and you need to take a new one.

Changing antidepressants in adults – UpToDate

Serotonin syndrome – MSD

Most often it is started again with a small dosage, this delays the process of obtaining the effect of treatment. The new drug may also have side effects – the same or different. We will have to wait again until they pass.

You won’t be able to change the drug on your own, since all antidepressants are sold only by prescription – and that’s good. Switching from one drug to another can be dangerous if you do not know the characteristics of different groups of drugs.

For example, taking SSRIs is possible only some time after the withdrawal of antidepressants from the group of monoamine oxidase inhibitors – due to the risk of developing serotonin syndrome. This is a potentially fatal condition, accompanied by a change in mental state, high fever, increased muscle tone and other symptoms.

If the drug is changed correctly, there will be no dangerous negative effects, so consultation with a doctor is required.

How to choose a psychotherapist

Fact No. 8

Among antidepressants there are original drugs and generics

Preparations may be original or generic. Originals are medicines first released by some pharmaceutical company that have passed all clinical trials and checks. Generics are drugs with the same active ingredient from another pharmaceutical company, that is, copied from the original drug.

Theoretically, the effect of generic drugs should not differ from the effect of original drugs. However, this is possible, since generics may contain other additional substances or the manufacturer may use other raw materials.

Due to my anxiety, I did not read anything in detail about specific drugs before I bought my first antidepressant in a pharmacy so as not to be scared and not think about taking it. I also didn’t think to ask the doctor about this question.

Psychoneurological complications after covid: memory problems and depression

As a result, I first bought a generic because it was in stock. Then it turned out that, after all, according to the experience of my psychiatrist, the original drug often gives fewer side effects and is better tolerated. As a result, I changed the generic to the original drug – and, indeed, the side effects softened.

In my subjective opinion, which is supported by some data, in the case of antidepressants and other psychotropic drugs, you should always choose the original medicine. Moreover, the cost of originals and generics is not always very different.

Originals and generics of some SSRIs

Sertraline

Original

Zoloft

Original cost

Approx. 002 Generics

Serenata, Serlift

Cost of generics

500-600 R , tablets 100 mg

Escitalopram

Original

Cipralex

Original cost

3000 R, tablets 10 mg

Generics

“Selektra”, “Elycea”

Cost of generics

500-1300 R, tablets 10 mg

Fluoxetine

Original

Prozac

Original price

About 350 R, tablets 20 mg

Generics

Profluzak, Fluoxetine

Cost of generics

100-200 R, tablets 20 mg

My pills: I bought several packs of Serenata at once, so one remained unclaimed ovannoy

Fact No. 9

Do not take alcohol along with antidepressants

Drinking alcohol while taking antidepressants may exacerbate unpleasant side effects. Also, alcohol is a depressant, that is, it has the opposite effect, and its intake can adversely affect the results of treatment.

Why you shouldn’t mix antidepressants and alcohol – Mayo Clinic

Alcohol is strictly forbidden to drink with some groups of antidepressants, for example, tricyclic antidepressants and monoamine oxidase inhibitors: combination with the latter, for example, can lead to an uncontrolled increase in pressure. MAO inhibitors in general require a special diet – it is unlikely that a doctor will prescribe such drugs as the first antidepressants, but if necessary, he will issue a list of what is allowed and prohibited.

With other antidepressants, moderate use may not be dangerous and even pass without consequences, but doctors still recommend abstaining so as not to increase side effects and improve treatment outcome.

The main thing is not to temporarily stop taking the drug in order to drink. This can lead to the development of a withdrawal syndrome.

How I Treated Generalized Anxiety Disorder under CHI

Fact No. 10

Antidepressants are incompatible with certain drugs and have contraindications

It is important to tell your doctor what medications you are taking and what chronic illnesses you have. For example, SSRIs may not be suitable for epilepsy and bleeding disorders, and tricyclic antidepressants are usually not prescribed for those who have recently had a heart attack, suffer from glaucoma, or porphyria.

Antidepressant Warnings – NHS

Drug Compatibility Test – Drugs.com

It is also important to be careful if you are about to take any over-the-counter medicine. For example, ibuprofen, which people often take on their own to relieve pain and reduce fever. It should not be taken with SSRIs as it increases the risk of gastrointestinal side effects.