Trazodone for Anxiety: Is It Effective?

What Is Trazodone?

Trazodone is an antidepressant medication that is FDA-approved for the treatment of depression.¹ Trazodone is a generic drug and is no longer sold in brand-name forms in the United States. Previous brand names of trazodone in the United States include Desyrel and Oleptro.

How Does Trazodone Work?

Trazodone belongs to a medication class called serotonin modulators.² These medications work by affecting serotonin levels in the brain.¹ Serotonin is a chemical that plays a major role in mood. Dysregulation of serotonin can lead to symptoms of depression and anxiety. By enhancing serotonin, trazodone may alleviate these symptoms. Trazodone may help with sleep for some people due to its sedative effect. This can be helpful in improving sleep in those with insomnia, which is a common symptom of mental health conditions. Using trazodone for insomnia is also an off-label indication.

Does Trazodone Help With Anxiety Symptoms?

Trazodone is only FDA-approved for the treatment of depression. However, trazodone may help with anxiety symptoms due to its ability to enhance serotonin in the brain. Because of this, it is sometimes prescribed off-label for the treatment of anxiety and other health conditions.

Off-label means the medication is being used to treat a condition not approved by the FDA. This is sometimes done when a healthcare provider believes, in their professional expertise, that the medication may still offer a benefit to an individual. Off-label uses of trazodone include insomnia, anxiety, Alzheimer’s disease, substance abuse, bulimia, fibromyalgia, and post-traumatic stress disorder (PTSD).

Types of Anxiety Treated with Trazodone

The use of trazodone for anxiety disorders is not FDA-approved, and its use for anxiety disorders has not been well studied. Because of this, it is unknown which types of anxiety may be treated with trazodone. Additionally, individual responses will vary when taking trazodone. Using trazodone off-label should always be done under the care of a healthcare provider.

Is Trazodone Like Xanax for Anxiety?

No, trazodone and Xanax are distinct medications that work differently from each other. Trazodone is primarily used as an antidepressant but may be prescribed off-label for anxiety. Xanax (alprazolam) belongs to the class of medications called benzodiazepines and is specifically used to treat anxiety disorders. Trazodone works by enhancing serotonin in the brain. In contrast, Xanax works by enhancing gamma-aminobutyric acid (GABA), leading to a calming effect on the brain.

It is important to note that side effects can vary across medications and individuals.

How Effective is Trazodone for Anxiety?

The effectiveness of trazodone for anxiety symptoms varies among individuals. It is considered off-label when used for anxiety, and its effectiveness on anxiety symptoms has not been well studied. If you have questions about how trazodone may work for your anxiety, talk with your healthcare provider.

How Quickly Does Trazodone Work for Anxiety?

The time it takes for anxiety to begin working can vary from person to person. Unlike more traditional anxiety medications with rapid effects, trazodone’s effect may take several weeks before the effects become noticeable.² This delay is due to how trazodone influences serotonin levels in the brain. The impacts on sleep, however, can be immediate.

How Long Do the Effects of Trazodone Last?

Trazodone remains in the body for approximately 25-45 hours, and the effects can be felt during this time.² However, the sedative effects usually resolve within 6 hours. Because of this, trazodone is generally taken at bedtime. The duration of trazodone’s effect can vary, however, based on individual metabolism, dosage, and condition being treated.

Who Might Benefit From Taking Trazodone for Anxiety?

Trazodone may be considered for individuals dealing with anxiety symptoms, especially those who experience difficulties with sleep. Because trazodone is primarily prescribed for depression, it may also be helpful in individuals who have anxiety and depression symptoms. Trazodone is not a first-line treatment for anxiety. Still, it may be helpful for individuals who have not had success with first-line treatments, such as selective serotonin reuptake inhibitors (SSRIs).

Side Effects of Trazodone for Anxiety

The side effects of trazodone may vary from individual to individual, with some individuals experiencing minimal side effects and others experiencing severe side effects. The most common side effects of trazodone are mild and resolve over time as the body adjusts to the medication. Although rare, some side effects can be serious and require immediate medical attention. It is important to know the possible side effects when taking trazodone. Because trazodone is not FDA-approved for anxiety treatment, the side effects were evaluated in depression patients.

Common side effects of trazodone for depression include*:¹

• Dry mouth
• Blurred vision
• Dizziness
• Drowsiness
• Headache
• Nausea
• Vomiting

*All medications, including trazodone, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Serious side effects of trazodone for depression that require immediate medical attention include*:^1,4

• Chest pain
• Irregular heartbeat
• Loss of consciousness
• Priapism (sustained and painful erections)
• Decreased blood pressure and fainting
• Difficulty breathing
• Swelling of the face, mouth, or throat
• Confusion
• Seizures

*All medications, including trazodone, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

The chance of developing side effects varies from individual to individual. The most common side effects include dry mouth, drowsiness, and dizziness. These side effects often resolve within a few days to weeks. If you develop severe side effects, seek immediate medical attention.

Trazodone for Anxiety Dosage

Trazodone has a broad range of doses available to meet individual needs. As using trazodone for anxiety is considered off-label, there are no specific guidelines for starting doses. The trazodone dosage can vary from 25 mg to 400 mg per day, depending on the condition being treated.²

Trazodone for Anxiety Warnings & Precautions

While trazodone may help with anxiety symptoms, it is important to be aware of the warnings and precautions associated with its use. Based on their medical history, some individuals may be at a higher risk of side effects when taking trazodone.

Warnings and precautions for taking Trazodone include:¹

• Suicidal thoughts: Taking antidepressants such as trazodone may increase the risk of suicidal thoughts and behaviors, particularly in children and young adults.
• Serotonin syndrome: Medications that enhance serotonin can lead to a dangerous condition called serotonin syndrome. Symptoms include mental status changes, labile heart rate and blood pressure, and seizures.
• Heart rhythm abnormalities: Individuals with a history of heart disease may be at an increased risk for heart rhythm abnormalities when taking trazodone.
• Low blood pressure: Some individuals taking trazodone may experience drops in their blood pressure, leading to fainting. Individuals taking medications to lower their blood pressure are at an increased risk.
• Risk of bleeding: Taking trazodone may increase the risk of bleeding, particularly for individuals taking blood thinners.
• Priapism: Painful and sustained erections, known as priapism, can be brought on by taking trazodone.
• Psychiatric events: Taking medications that impact serotonin can lead to manic episodes, especially in individuals with a history of bipolar disorder.
• Discontinuation syndrome: Individuals taking trazodone may experience side effects when stopping this medication. The risk of antidepressant discontinuation can be reduced or avoided by tapering off the medication.
• Cognitive and Motor Impairment: Trazodone may impair the ability to have mental or physical ability to complete tasks. This is especially important for driving, operating machinery, or performing any task that could be harmful.
• Low Levels of Sodium: Taking trazodone can cause hyponatremia or low levels of salt in your body. This can lead to side effects and even coma or death if it is left untreated.

There may be additional warnings or precautions with this medication. Talk with your healthcare provider about all the risks before you start taking this medication.

How To Take Trazodone for Anxiety

Trazodone should always be taken as recommended by your healthcare provider and pharmacist. Because this medication can cause drowsiness, it is often taken at night. However, the medication is sometimes prescribed to be taken twice per day. The medication should be swallowed whole or broken in half on the score mark. It can be taken with food and should always be taken around the same time every day.

What Happens If I Miss a Dose of Trazodone?

If you forget to take a dose of trazodone, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose. Never take double the dose to make up for a missed one.

If you have missed a dose and aren’t sure if you should take it, contact your pharmacist or healthcare professional.

What Is the Best Time to Take Trazodone?

As trazodone can cause drowsiness, it is usually taken at night before bedtime. However, this depends on the condition being treated. Trazodone should be taken as recommended by your healthcare provider and pharmacist.

What Does Trazodone Feel Like for Anxiety?

The experience of taking trazodone for anxiety can vary widely among individuals. As trazodone primarily affects serotonin levels in the brain, its effects are often subtle and gradual. Some individuals may experience a sense of calmness and reductions in their anxiety symptoms over time. Additionally, the medication can have sedative effects, leading to a feeling of relaxation and an easier ability to fall asleep.

How to Get a Prescription for Trazodone for Anxiety

Trazodone is only available through prescription by a healthcare provider. To get a prescription for trazodone, start by scheduling an appointment with your healthcare provider. These professionals will be able to assess your situation to determine if trazodone is an option for you. If you are looking for a new healthcare provider, one option to consider is working with an online psychiatry service. These platforms provide a convenient and accessible way to meet with a healthcare professional.

How to Know if Trazodone for Anxiety Is Working

Determining if trazodone is effectively managing anxiety involves assessing both subjective and objective indicators. On a subjective level, individuals may note a gradual reduction in the frequency and intensity of anxiety symptoms. These individuals may also notice improved sleep quality and a general sense of quality.

Healthcare providers may use standardized assessments and questionnaires to monitor your progress. It is important to have frequent follow-up appointments, especially early on, with your healthcare provider.

Alternative Treatments for Anxiety

If you are considering using trazodone for anxiety, it is essential to be aware of the various treatment options that exist. There are many pharmacological and non-pharmacological treatments for anxiety. Pharmacological options include other medications used in the treatment of anxiety. These medications may include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines. Each of these types of medications has its own benefits and considerations when used for anxiety.

Non-pharmacological options include different types of therapy, online group therapy, or support groups. Cognitive behavior therapy (CBT for anxiety) is a widely recognized therapeutic approach for the management of anxiety disorders. Exposure therapy is another type of therapy commonly used for anxiety disorders.

Alternative treatments for anxiety include:

• Selective serotonin reuptake inhibitors (SSRIs): A class of antidepressant medication commonly prescribed for anxiety disorders. SSRIs work by increasing the levels of serotonin in the brain. Examples of SSRIs include fluoxetine, sertraline, and citalopram.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): Another class of antidepressants used in treating anxiety. SNRIs work by increasing levels of serotonin and norepinephrine in the brain. Examples include venlafaxine and duloxetine.
• Benzodiazepines: A commonly used medication for the treatment of anxiety. Benzodiazepines work by increasing gamma-aminobutyric acid (GABA) in the brain. Examples include diazepam, alprazolam, and lorazepam.
• Buspirone: This medication works by mimicking serotonin in the brain and can lead to improved anxiety symptoms. Buspirone also goes by the brand name BuSpar.
• Cognitive behavioral therapy: This type of therapy is commonly used for the management of anxiety and depression. CBT for anxiety focuses on finding practical solutions to the triggers and symptoms of anxiety.
• Exposure therapy: This is another type of therapy commonly used for the management of anxiety. Exposure therapy focuses on gradual and safe exposure to anxiety triggers, leading to decreased anxiety symptoms and increased comfort in a variety of situations.

Questions to Ask Your Healthcare Provider About Trazodone for Anxiety

If you are considering trazodone for anxiety, it’s crucial to engage in an open and honest conversation with your healthcare provider. You may want to discuss your options and have questions answered by your primary physician, psychiatrist, and therapist. Before your appointment, be prepared with a list of questions you might have.

Questions to ask your care team when considering the side effects of trazodone may include:

• Can I use trazodone along with therapy to treat anxiety?
• How long will it take for me to adjust to taking trazodone?
• How long will trazodone last in my system?
• Am I at risk for more severe symptoms if I am already taking other anxiety /depression medications?
• What is the best dosage to ensure fewer side effects?
• Are there drugs I am taking that could have negative interactions?
• When should I reach out to you if I am experiencing side effects?
• Is there anything I should tell my therapist about this new medication?
• Are there any lifestyle factors that may affect trazodone’s efficacy or side effects?
• How might trazodone impact my daily activities, such as work or driving?
• Are there potential long-term effects or considerations when using trazodone?
• How often should I schedule follow-up appointments?
• Can drinking alcohol while taking trazodone impact my anxiety?