One common medication often used to treat depression (major depressive disorder) is trazodone (previously known by the brand name Desyrel). On this page, we’ve outlined some important information about the drug.

What is trazodone (Desyrel)?

What is trazodone? How does it work?

Trazodone is an antidepressant approved to treat conditions such as major depressive disorder, and it is typically prescribed as a sleep aid, off-label. It may also be used off-label to treat anxiety, insomnia, or schizophrenia.

Trazodone belongs to a class of medications called serotonin modulators. This class of medications act by increasing the levels of the neurotransmitter serotonin in the brain to improve mood and mental balance.

How is trazodone typically used?

A common starting dosage for trazodone is 50mg at bedtime. Often, doctors will start their patients off on low doses and increase the dosage over time, if needed. This helps reduce side effects. As a result, it might take some time to begin seeing the full benefits of trazodone. 

Trazodone is available in different types of tablets (regular and extended release). Sometimes regular tablets will be taken in divided doses, while extended release tablets can be taken as a single dose. 

Do not stop taking trazodone without talking to your doctor, as this may cause a negative reaction. If your doctor feels that you are ready to stop taking trazodone, they will gradually reduce your dose over several weeks until it is safe to stop taking the medication altogether. This process is often called “tapering”.

What are some possible side effects?

Some common side effects of trazodone include:

• Headache
• Nausea and vomiting
• Diarrhea
• Weakness 
• Dizziness or lightheadedness

Some serious (but uncommon) side effects include:

• Seizures
• Chest pain
• Loss of consciousness (coma)
• Pounding or irregular heartbeat
• Unusual bruising or bleeding
• Priapism (an unusually long erection of the penis)

Call 911 or seek emergency care if you notice any severe side effects. You can find a more comprehensive list of trazodone side effects here. 

Why do these side effects occur? 

Any medication can potentially lead to side effects, and a person’s likelihood of having side effects depends on many factors, including age, lifestyle, and the type of medication itself. Side effects may occur because drugs often have broad or poorly targeted effects, or the drug target itself may have many downstream effects on the body. For example, though trazodone targets serotonin to help improve mood, there are other areas affected by serotonin, such as sleep and concentration, and changes in serotonin levels can impact these areas. 

Many non-serious side effects of mental health medications like trazodone go away after a few weeks as your body gets used to the medication. However, if a side effect persists, is intolerable, or severely hinders your ability to go about your daily life, talk to your doctor, because this might be a sign that the medication is not a good fit. 

How do your genes relate to trazodone? 

Genetics can affect your body’s response to medication. Serotonin is broken down in the body by the enzyme CYP3A4. Some people with a certain variation of the CYP3A4 gene might be “slow metabolizers” of trazodone. Being a slow metabolizer means your body will break down the medication more slowly than others, which means the drug sticks around in your body for longer than average and may lead to side effects. For slow metabolizers, a doctor might opt to prescribe a different medication or prescribe a lower dosage. 

One way to predict whether you’ll have a positive outcome while taking trazodone is by taking a genetic test to determine what genetic variations you have and how they affect medication metabolization. Your DNA can help your doctor rule out less suitable medications and make more informed decisions so that you can get better, faster.

Special Precautions

• Trazodone can make you feel drowsy and lightheaded. Avoid driving or handling heavy machinery after using the medication. 
• Taking trazodone can increase the likelihood of suicidal thoughts in teenagers and young adults. Inform your doctor immediately if you feel more depressed or are feeling like hurting yourself after taking the medication. 
• Inform your doctor immediately if you feel any pain in your chest or in your breathing after taking trazodone, this could be a sign of something serious. 
• Trazodone can increase the cognitive impairment effects of alcohol. Talk with your doctor about the safety of taking alcohol alongside your medication. 

If you show signs of an allergic reaction to trazodone (hives, difficulty breathing, rash, swelling), call 911 or go to the nearest emergency department.

Some medications, vitamins, and herbs may interfere with how trazodone works. Make sure to tell your doctor about all other medications you are taking before starting trazodone to avoid negative interactions. For full details, see the FDA’s full list of precautions.

Looking to find the right medication for your mental health? Join Prairie today to connect to expert providers and affordable medication options.