Trazodone for Sleep and Depression in Oregon and Washington

What It Is

Trazodone is an older atypical antidepressant that's FDA approved for major depressive disorder. In reality, it's prescribed for insomnia way more often than for depression these days. Not a controlled substance, not addictive, cheap as hell, and sedating enough that it works for sleep.

Comes in 50mg, 100mg, 150mg, and 300mg tablets. For sleep, typical doses are 25mg to 100mg. For depression, you'd need 150mg to 300mg, but hardly anyone uses it for that anymore.

What It Does

At low doses (25-100mg), trazodone works primarily as a sleep aid. It causes sedation through antihistamine effects and helps you fall asleep. Doesn't keep you asleep all night as reliably as some other sleep meds, but it helps with sleep onset.

At higher doses (150-300mg), it functions as an antidepressant by affecting serotonin systems. Nobody really prescribes it at antidepressant doses anymore because there are better options, but that's what it was originally designed for.

How It Works

Trazodone blocks certain serotonin receptors and has antihistamine properties. The sedation comes mainly from the antihistamine effects and from blocking specific serotonin receptors. That's why it works for sleep at low doses.

For antidepressant effects at higher doses, it works as a serotonin antagonist and reuptake inhibitor (SARI). Different mechanism than SSRIs but similar goal of increasing serotonin activity.

Most people taking it for sleep don't need to understand the antidepressant mechanisms because they're not taking enough to get antidepressant effects anyway.

What It Feels Like When It's Working

You take it 30 minutes to an hour before bed, you start feeling drowsy and heavy, you lie down and hopefully you fall asleep within an hour. Sleep quality can be decent. You might wake up during the night but often fall back asleep fairly easily.

Next morning, hopefully you wake up feeling rested. Some people experience grogginess or a hangover feeling, especially at higher doses or when first starting.

Common Side Effects

Drowsiness and sedation are the point when using it for sleep, but next-day grogginess can be a problem for some people.

Dizziness, particularly when standing up quickly (orthostatic hypotension). This can be significant, especially in older adults.

Dry mouth is very common.

Headache can happen.

Nausea is possible but usually mild.

Some people feel foggy or cognitively slower the next day.

Priapism is the scary one. This is a prolonged, painful erection lasting more than 4 hours. It's rare but it happens, and it's a medical emergency. If you have an erection lasting more than 4 hours on trazodone, you need to go to the ER immediately. This can cause permanent damage if not treated. Affects men, obviously. This risk is one reason some providers are hesitant to prescribe trazodone to men even though the actual incidence is low.

Weight changes are possible but less dramatic than with something like Remeron.

What It Looks Like When It's Not Working

You're taking it and you're still lying awake, or you fall asleep but wake up repeatedly and can't get back to sleep. Or you sleep but wake up feeling terrible.

Sometimes the dose needs adjustment. For sleep, typical range is 25-100mg. Some people need more, some need less. Sometimes trazodone just doesn't work for your particular insomnia.

If you're waking up feeling hung over and groggy every day, the side effects might outweigh any benefit even if you're sleeping better.

Timeline for Noticing Effects

Works the first night. You take it, feel drowsy within 30-60 minutes, hopefully fall asleep. You're not waiting weeks for it to build up.

If you've taken it correctly (before bed, gave yourself time to sleep) and you don't feel any effect, either the dose is too low or trazodone isn't going to work for you.

Real Talk About Trazodone in the Pacific Northwest

Trazodone is prescribed constantly for insomnia because doctors like it, patients tolerate it reasonably well, and insurance companies love it because it's dirt cheap. Generic trazodone costs like $4 for a month's supply. Compare that to Ambien or Lunesta and you can see why it's popular.

It's not a controlled substance, which means prescribers don't have to deal with DEA oversight and patients don't have to deal with pharmacy hassles. For people with substance use history or providers who are cautious about prescribing controlled substances, trazodone is an easy choice.

The effectiveness is decent but not amazing. It helps a lot of people fall asleep. It doesn't keep everyone asleep all night. It's not as reliable as Z-drugs like Ambien but it's also not causing Ambien walrus behavior or dependence issues.

The priapism thing scares people but it's actually quite rare. Still, it's serious enough that if you're a man taking trazodone, you need to know about it. Any erection lasting more than a couple hours needs medical attention. More than 4 hours is an emergency. This isn't a joke about having a good time, it's a medical emergency that can cause permanent erectile dysfunction if not treated.

Next-day grogginess is hit or miss. Some people feel fine the next day, others feel hung over and sluggish. Usually improves after the first week or two as your body adjusts, but not always.

Our team prescribes trazodone throughout Oregon and Washington (Portland, Salem, Eugene, Spokane, Vancouver, Bellingham, Tri-Cities) fairly frequently for insomnia, especially when patients want to avoid controlled substances or when cost is a major factor.

Mixing trazodone with alcohol increases sedation and dizziness significantly. Not as dangerous as mixing alcohol with benzodiazepines or Z-drugs but still not a good idea.

If you've been taking trazodone every night for months and you're still having significant insomnia, there's something else going on that needs to be addressed. Chronic insomnia usually has underlying causes (anxiety, depression, sleep apnea, chronic pain, whatever) and just taking a sleep med forever isn't fixing the actual problem.

Some people find that trazodone works great for a while and then stops working as well. Tolerance can develop with nightly use. Taking breaks or using it intermittently rather than every single night can help.

Sleep Treatment Throughout Oregon and Washington

LiveWell Psychiatry and Men's Health provides insomnia treatment for patients throughout Oregon and Washington, including Portland metro, Vancouver and Clark County, Salem, Eugene, Corvallis, Bend, Spokane, Tri-Cities, and surrounding communities. If you're dealing with chronic sleep problems, we can evaluate what's actually causing your insomnia and whether trazodone or another approach makes sense.

Trazodone is a solid, practical option for insomnia. It's not fancy, it's not the strongest, but it works for a lot of people and it's affordable and accessible. The priapism risk is real but rare, the next-day grogginess is common but usually manageable, and the effectiveness is good enough that it's worth trying if you need help sleeping and want to avoid controlled substances.