Not every medication survives the decades with renewed relevance, but trazodone has done just that. Originally introduced as an antidepressant in the 1960s, it has slowly found its way into modern practice as one of the most commonly prescribed off-label sleep aids. Its story is one of pharmacology, clinical pragmatism, and patient-centered use.

What Is Trazodone?

Trazodone belongs to the class of serotonin antagonist and reuptake inhibitors (SARIs). It blocks serotonin 5-HT2A receptors while modestly inhibiting serotonin reuptake. Unlike many antidepressants, it does not strongly stimulate noradrenaline or dopamine systems—making it generally calming rather than activating.

Why Is It Used for Sleep?

At low doses (25–100 mg), trazodone’s sedative properties dominate. These effects come from:

• 5-HT2A antagonism → promotes slow-wave sleep

• Histamine H1 receptor blockade → mild antihistamine action adds to drowsiness

• Alpha-1 adrenergic blockade → contributes to sleepiness and relaxation

Unlike benzodiazepines or “Z-drugs,” trazodone doesn’t significantly suppress deep sleep architecture, which is why some clinicians prefer it in long-term insomnia management.

Beyond Insomnia

Trazodone is sometimes chosen when insomnia coexists with:

• Depression or residual symptoms after other antidepressants

• Anxiety disorders where sleep is fragmented by worry

• Chronic pain conditions, since sedation may help with restorative rest

• Substance use disorders, as it has a lower risk of abuse compared to sedatives

The Evidence So Far

• Sleep quality: Studies show trazodone improves total sleep time, reduces night awakenings, and enhances deep sleep.

• Depression: At higher doses (150–300 mg), it remains an antidepressant option, though now overshadowed by SSRIs and SNRIs.

• Safety: It’s widely used, but not without caution. Side effects like morning grogginess, dizziness, or dry mouth are common. Rare but notable risks include orthostatic hypotension and priapism.

Practical Considerations

• Typical dosing for sleep: 25–100 mg at bedtime.

• Onset: Usually within 30–60 minutes.

• Duration: Sedative effects last 6–8 hours for most.

• Cautions: Avoid alcohol, monitor in elderly (fall risk), and use carefully with other serotonergic drugs to reduce serotonin syndrome risk.

The Bottom Line

Trazodone is not the shiny new molecule on the block—it’s an old antidepressant repurposed into a trusted sleep tool. For patients who don’t respond to behavioral interventions alone, or when insomnia is tied to mood or anxiety conditions, trazodone continues to earn its place in psychiatric practice.

About Me

I’m Dr. Srinivas Rajkumar T, Consultant Psychiatrist, researcher, and writer with a keen interest in psychopharmacology and practical approaches to mental health care. I write regularly about sleep, mood, and evidence-based strategies that help patients reclaim balance in their lives.

💻 Read more at srinivasaiims.com
📞 For consultations, contact: 8595155808