Trazodone — what it is and why people take it

Many people know trazodone as a sleep aid, but it was developed as an antidepressant. It’s a SARI (serotonin antagonist and reuptake inhibitor), which makes it work differently from typical SSRIs. Doctors prescribe it for depression, insomnia, and sometimes for anxiety or pain-related sleep problems. Because it’s sedating, low doses often help sleep while higher doses treat mood disorders.

How trazodone is used and dosed

For trouble sleeping, prescribers commonly suggest 25–100 mg at bedtime. For depression, typical starting doses are around 150 mg per day, often split into two or three doses, and some people need 150–300 mg daily under close supervision. Doses above 400 mg are uncommon and need specialist oversight. Always follow your prescriber’s plan — don’t self-adjust based on how you feel that day.

Take trazodone with food if your doctor recommends it; food can increase absorption and may reduce light-headedness. If it makes you groggy the next day, try a lower dose or an earlier bedtime and talk to your clinician before changing anything.

Side effects, risks and interactions

Common effects are drowsiness, dry mouth, dizziness, blurred vision, constipation, and low blood pressure when standing (orthostatic hypotension). Older adults are more prone to falls because of dizziness and sedation — doctors usually start low and move slowly.

Rare but serious issues: priapism (a painful, lasting erection) and serotonin syndrome. If an erection lasts more than four hours or you see signs of serotonin syndrome — high fever, rapid heartbeat, severe agitation, tremors, or confusion — get emergency care.

Trazodone interacts with other medicines. Don’t combine it with MAO inhibitors (wait at least 14 days) and be cautious with other serotonergic drugs like SSRIs, SNRIs, triptans, and some migraine meds because of serotonin syndrome risk. Drugs that affect CYP3A4 (ketoconazole, clarithromycin, some HIV meds) can raise trazodone levels and side effects. Alcohol and opioid or benzodiazepine sedatives add to drowsiness and breathing risk — avoid mixing.

If you’re pregnant, breastfeeding, have heart disease, severe liver problems, or a history of bipolar disorder, mention this to your prescriber — trazodone may need extra care or a different choice. When stopping trazodone, don’t quit suddenly; tapering helps avoid withdrawal and rebound insomnia or mood symptoms.

Practical tip: keep a short list of all medications and supplements to show your provider, note any new symptoms in a simple journal for the first few weeks, and ask about timing (bedtime vs split dosing) to reduce next-day tiredness. If you’re unsure whether trazodone fits your situation, a quick call to your clinician can save a lot of trouble.