Trazodone is an antidepressant that is sometimes prescribed as a sleep aid. It is not addictive and may offer additional benefits over other sleep aids for certain conditions, such as sleep apnea.

Trazodone is a prescription medication approved by the Food and Drug Administration (FDA) for depression.

One of its key actions is regulating the neurotransmitter serotonin. Serotonin helps brain cells communicate with each other and influences sleep, thoughts, mood, appetite, and behavior.

Even at lower doses, trazodone may cause sleepiness because it blocks chemicals in the brain that interact with serotonin and other neurotransmitters, such as 5-HT2A, alpha1 adrenergic, and H1 histamine receptors.

This effect may be one of the main reasons trazodone works as a sleep aid.

Keep reading to learn more about what to consider before taking trazodone for sleep.

FDA warning about trazodone

Like many antidepressants, trazodone has been issued a “Black Box Warning” by the FDA.

Taking trazodone has increased the risk of suicidal thoughts and behaviors in children and young adults. People taking this medication should be closely monitored for worsening symptoms and the development of suicidal thoughts and behaviors.

Trazodone is not approved for use in children.

Trazodone (Desyrel, Molipaxin, Oleptro, Trazorel, and Trittico) is approved by the FDA as an antidepressant in adults, but for many years, doctors have also prescribed it as a sleep aid.

The FDA approves medications to treat specific conditions based on clinical trials.

However, doctors sometimes prescribe a drug for conditions other than what it was approved for. This is known as off-label prescribing.

Prescribing trazodone for sleep is considered off-label.

Off-label use of a medication is a widespread practice. A 2023 review found that up to 1 in 3 medications are prescribed off-label in the United States.

Trazodone is most often prescribed at doses between 50 milligrams (mg) to 100 mg as a sleep aid.

A 2023 review found that 50 mg of trazodone taken before bed may help you:

  • fall asleep quicker
  • stay asleep
  • sleep for longer

Lower dosages may also cause less daytime sleepiness and fewer side effects because the drug is short-acting.

First-line treatment for insomnia and other sleeping problems includes non-pharmacological methods like improving sleep hygiene, practicing relaxation methods, and cognitive behavioral therapy (CBT).

If these treatments are ineffective, a doctor may recommend over-the-counter or prescription medications to help you sleep.

A doctor may prescribe trazodone for sleep for several reasons:

  • Reduced cost: Trazodone may be less expensive than other insomnia drugs because it’s available generically.
  • Not addictive: Doctors do not consider trazodone to be addictive like other medications, such as benzodiazepines.
  • May help prevent cognitive decline: Trazodone might help improve slow-wave sleep, which may slow certain types of age-related mental decline like dementia in older adults.
  • May be better for obstructive sleep apnea (OSA): A 100 mg dose of trazodone may help improve respiratory arousal threshold if you have OSA. This means you may be less likely to wake up during the night.

Trazodone may cause some side effects, especially when first starting the medication. These may include:

It’s important to discuss possible side effects and concerns you may have with a doctor before taking trazodone.

Although rare, trazodone may cause serious reactions. Call 911 or local emergency services if you experience any life threatening symptoms, such as difficulty breathing.

According to the FDA, serious risks of taking trazodone may include:

If you’re considering stopping trazodone, speak with a doctor about the best way to slowly reduce your dosage. Suddenly stopping trazodone may cause withdrawal symptoms, known as discontinuation syndrome, because your body has become used to the drug.

Trazodone overdose

There have been reports of overdose with trazodone use. The risk is higher if you combine trazodone with alcohol, benzodiazepines, or other central nervous system depressant drugs that can slow your breathing and reactions.

Drug overdose could be fatal. If you suspect you have taken too much trazodone, call 911 or local emergency services and seek medical attention immediately.

Symptoms of overdose

Symptoms of trazodone overdose may include:

Trazodone is a medication approved for use by the FDA in 1981 as an antidepressant.

Given in lower doses, it may help improve sleep and cause less daytime sleepiness or drowsiness.

Although trazodone use for sleep is common, the American Academy of Sleep Medicine doesn’t recommend it as a first line of treatment for insomnia.

Consider speaking with a healthcare professional about ways to improve your sleep, which may include lifestyle, dietary, and behavioral changes.