Is trazodone a controlled substance?

Is trazodone a controlled substance?

Trazodone isn't a controlled substance but does have sedating effects. This is why it's more commonly prescribed for insomnia rather than depression.

Reviewed by:
Laura Ginory, MD
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May 19, 2024
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Key takeaways

Trazodone, an antidepressant, is not a controlled substance. This means that the risk for dependence and misuse is low. However, it’s not as commonly used to treat depression due to its sedative qualities.

In this article we’ll explain how it works, what conditions it can treat, potential side effects, and some alternative antidepressants that you might consider.


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What is trazodone and what is it used for?

Trazodone was initially FDA-approved for the treatment of major depressive disorder, though it’s typically not prescribed as much for it due to its sedating effects.

Nowadays, trazodone is more frequently prescribed off-label for other conditions. These include:

  • Insomnia
  • Anxiety

“Off-label” means the drug has not been approved by the FDA to treat these specific conditions. However, that doesn’t mean that these uses aren’t safe, but rather are prescribed based on scientific research validating its effectiveness. But be sure to always follow your doctor’s instructions about when and how to take trazodone.

Is trazodone a sleeping pill?

Trazodone is not a sleeping pill but has sedative effects due to its antihistamine properties, and not how it affects serotonin. Like most antidepressants, trazodone works by affecting the chemical messengers that your brain uses to communicate between brain cells, called neurotransmitters. However, trazodone is an atypical antidepressant, which means that it doesn’t fit into the main categories that most other antidepressants do.

Trazodone is a serotonin antagonist and reuptake inhibitor, meaning it influences your brain’s levels of serotonin. This neurotransmitter is involved in regulating your mood, and although depression isn’t caused by merely a shortage of serotonin, it’s well-established that drugs that affect the availability of this neurotransmitter in your brain can help treat depression.

Can you take trazodone for insomnia?

Trazodone has a sedative effect, and for this reason, it is also commonly prescribed to treat insomnia. In fact, it is used to treat insomnia (an off-label use) more often than it is used to treat depression.

For some people, the fact that trazodone is not a controlled substance, like opioids, is a potentially huge benefit when using it as a sleep aid, as many other prescription sleep aids carries the risk of addiction, dependency, and misuse when used long term, trazodone is usually prescribed at a lower dose than it would be as an antidepressant for sleep—50-200mg, compared with the 150- 600mg range that is typically used in the treatment of depression.

Despite the fact that Trazodone is so commonly prescribed for insomnia, it may not be safe for everyone due to its potential side effects (see below). More research is needed to understand  if it actually works to treat insomnia and if the benefits of the drug outweigh the risks that some of its side effects may pose.

What should not be mixed with trazodone?

Whether you’re considering trazodone for treatment of depression, anxiety, insomnia, or one of its other common uses, you should avoid taking it at the same time as any of the following drugs without consulting your physician

  • Certain medications for fungal infections like fluconazole, itraconazole, ketoconazole, posaconazole, voriconazole
  • Cisapride
  • Dronedarone
  • Linezolid
  • Monoamine oxidase inhibitors (MAOIs) like Carbex, Eldepryl, Marplan, Nardil, and Parnate
  • Mesoridazine
  • Methylene blue
  • Pimozide
  • Saquinavir
  • Thioridazine
  • Tramadol

Trazodone might also interact with other drugs and substances, including but not limited to alcohol, antiviral medications, fentanyl, and lithium. You should always tell your doctor about any over-the-counter and prescription drugs you’re taking whenever you’re considering starting a new medication.

In addition to potential drug interactions, there are other health conditions that your doctor needs to be aware of to minimize risk of adverse effects before starting Trazodone, so make sure to tell your doctor if:

  • You’ve ever attempted suicide or are having suicidal thoughts
  • You have bipolar disorder
  • You have bleeding problems
  • You have glaucoma
  • You have heart disease, or have had a previous heart attack
  • You have an irregular heartbeat
  • You have kidney or liver disease
  • You have low levels of sodium in the blood
  • You have had an unusual or allergic reaction to trazodone, other medications, foods, dyes, or preservatives
  • You are pregnant or trying to get pregnant
  • You are breastfeeding

Simply having these conditions doesn’t mean that you absolutely can’t take trazodone—it’s something you and your doctor can decide together, weighing the benefits and risks of taking Trazodone for your particular situation.


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Potential side effects

Like any drug, trazodone has side effects. They range from the common and less concerning ones to the more severe. Your doctor will discuss these with you before prescribing, and if you have any specific concerns always reach out to them.

The common side effects of trazodone include:

  • Nausea and vomiting
  • Dizziness
  • Drowsiness
  • Hypertension
  • Dry mouth

These side effects don’t usually require medical attention, but if they don’t go away with continued use or are particularly bothersome to you, you should bring them up to your doctor.

The more rare but serious side effects, which you should bring to the attention of a medical professional as soon as possible, are:

  • Signs of allergic reactions: skin rash, itching, hives, swelling of the face, lips, tongue, or throat
  • Unusual bruising or bleeding: bloody or black stools; red or dark brown urine; vomiting blood or brown material that looks like coffee grounds; small red or purple spots on skin
  • Heart-rhythm changes: fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
  • Low blood pressure: dizziness, feeling faint or lightheaded, blurry vision
  • Low sodium level: muscle weakness, fatigue, dizziness, headache, confusion
  • Prolonged or painful erection
  • Symptoms of serotonin syndrome, like irritability, confusion, fast or irregular heartbeat, muscle stiffness, twitching muscles, sweating, high fever, seizures, chills, vomiting, diarrhea
  • Sudden eye pain or change in vision: blurry vision, seeing halos around lights, vision loss
  • Thoughts of suicide or self-harm, worsening mood, feelings of depression

If you have any other side effects or concerns while taking trazodone, be sure to discuss them with a mental-health professional, like a psychiatrist.

What are other medications for depression?

If you are interested in treating your depression with medication but aren’t sure if trazodone is the right option for you, you might consider some of the other kinds of antidepressant medications.

  • Selective serotonin reuptake inhibitors (SSRIs) like citalopram (brand name Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft).
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs): This class of drugs influences the amounts of both serotonin and norepinephrine—a neurotransmitter and hormone that influences mood and memory, among other things. Desvenlafaxine (brand name Pristiq), duloxetine (Cymbalta), levomilnacipran (Fetzima), and venlafaxine (Effexor XR) are some common SSRIs. Like SSRIs, SNRIs are usually considered safe and effective.
  • Monoamine oxidase inhibitors (MAOIs): The first kind of antidepressants developed, but these days they’re prescribed less often and have mostly been replaced by SSRIs and SNRIs. They have some undesirable side effects like high blood pressure that might require diet changes. The MAOIs that are FDA-approved for treating depression are isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate).
  • Tricyclic antidepressants (TCAs): These are another type of medication that affects neurotransmitters to help alleviate depressive symptoms. TCAs include amitriptyline (Elavil) and doxepin (Silenor).
  • Atypical antidepressants: These are medications that don’t fit into the classes above and include mirtazapine (Remeron) and bupropion (Wellbutrin).

Whatever medication you’re curious about, you’ll need to work with a mental health professional to make sure you’re prescribed a medication that makes sense for you, your life, and your symptoms. If you don’t already have a psychiatrist Talkiatry makes moving forward easy: Take our quick assessment to be matched with one of our psychiatrists. and schedule your first virtual visit.

FAQs

Here’s more answers to your questions about trazodone.

Is trazodone like Xanax?

Trazodone and Xanax are different medications with distinct purposes and mechanisms of action. Trazodone is primarily used to treat depression and insomnia, while Xanax is a benzodiazepine primarily prescribed for anxiety disorders and panic disorder (although it can sometimes be used for insomnia). They both can cause drowsiness, but Xanax has a higher risk of dependency and abuse potential compared to trazodone. Learn about alternatives to Xanax.

Does trazodone make you gain weight?

Trazodone may cause weight gain in some individuals, but it’s not a universal side effect. Weight changes can vary depending on individual factors such as metabolism and lifestyle. If you’re concerned about weight gain while taking trazodone, discuss this with your healthcare provider.

Is trazodone used for anxiety?

Trazodone is commonly prescribed for its sedative effects. However, it’s not the first-line treatment for anxiety, and other medications like SSRIs are more commonly prescribed for this purpose. Always consult with a mental health professional for guidance on medication options for anxiety.

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.

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At Talkiatry, we specialize in psychiatry, meaning the diagnosis and treatment of mental health conditions. Your psychiatrist will meet with you virtually on a schedule you set together, devise a treatment plan tailored to your specific needs and preferences, and work with you to adjust your plan as you meet your goals.

If your treatment plan includes medication, your psychiatrist will prescribe and manage it. If needed, your psychiatrist can also refer you to a Talkiatry therapist.

What's the difference between a therapist and psychiatrist?

Psychiatrists are doctors who have specialized training in diagnosing and treating complex mental health conditions through medication management. If you are experiencing symptoms of a mental health condition such as depression, anxiety, bipolar disorder, PTSD, or similar, a psychiatrist may be a good place to start.  

Other signs that you should see a psychiatrist include:  

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  • You are interested in taking medication to treat a mental health condition  
  • Your symptoms are severe enough to regularly interfere with your everyday life

The term “therapist” can apply to a range of professionals including social workers, mental health counselors, psychologists, professional counselors, marriage and family therapists, and psychoanalysts. Working with a therapist generally involves regular talk therapy sessions where you discuss your feelings, problem-solving strategies, and coping mechanisms to help with your condition.

How does Talkiatry compare to face-to-face treatment?

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About
Laura Ginory, MD

Dr. Laura Ginory is double-boarded in child and adolescent psychiatry and adult psychiatry. She has been practicing for over 11 years.

Dr. Ginory's practice focuses on medication management, which is offered in conjunction with supportive therapy offered in 30-minute visit follow-up visits. However occasionally Dr. Ginory may believe additional therapy is needed and ask that you bring a therapist into your care team to provide the best outcome

Dr. Ginory received her medical degree from the University of Puerto Rico School of Medicine in San Juan, Puerto Rico. She completed her residency in adult psychiatry at Jackson Memorial Hospital in Miami, FL. She pursued her fellowship in child and adolescent psychiatry at the University of Florida, in Gainesville. After completing training, Dr. Ginory worked with children and adults in a variety of settings including Community Mental Health Centers and hospitals, providing both inpatient and outpatient services.

Dr. Ginory then became a Clinical Assistant Professor for the University of Florida Department of Psychiatry and provided clinical services for UF Student Mental Health at the Counseling and Wellness Center. While treating a wide variety of patients, her clinical focus has been in treating adolescents and young adults with mood and anxiety disorders.

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