Amanda has taught high school science for over 10 years. She has a Master's Degree in Cellular and Molecular Physiology from Tufts Medical School and a Master's of Teaching from Simmons College. She is also certified in secondary special education, biology, and physics in Massachusetts.
What Is Trazodone?
Imagine being a psychiatrist. A patient comes in complaining of chronic fatigue. He says he just feels empty lately. Work, his boyfriend, nor his friends feel fulfilling anymore. It's damaging his relationships and hurting his performance at his job. As a top notch doctor, you recognize these feelings as symptoms of depression. Since your patient already sees a therapist, you suggest he tries a pharmacological, or drug, intervention. One of the tools in your arsenal is a medication called trazodone. Trazodone is an anti-depressant. It is available only by prescription, and in certain people, it can alleviate symptoms of depression. Trazodone is available in oral form as a standard pill or as an extended release pill which works over a longer time period.
Effects of Trazodone
Trazodone works by changing the level of certain neurotransmitters in your brain. Neurotransmitters are chemicals that your brain cells, or neurons, use to talk to each other.
When the combination of these chemicals are altered, you think and feel things differently. Trazodone increases the level of a neurotransmitter called serotonin. Serotonin is associated with happy feelings and pleasure. Some people with depression have low serotonin levels, so they feel less happiness. Increasing serotonin levels can sometimes alleviate depression. Not all forms of depression can be treated with trazodone. It's important to follow your doctor's recommendations and monitor symptoms to see if the trazodone is working.
Before your patient commits to trying trazodone, he or she wants to know more about how it will effect him or her and what he or she should expect. Since your patient is an adult, you explain you'll start with a standard dose of 150mg per day and possibly increase it as needed up to 375mg. You remind your patient that medications take time to start working, and he or she might not notice his or her symptoms change for 2-4 weeks. However, it's important to keep taking the medication exactly as directed at the same time each day.
Side Effects and Concerns
Being an ethical psychiatrist, you need to warn your patient about possible side effects and drug interactions, too. You explain that trazodone may cause dizziness and sleepiness. In fact, sleepiness is such a common side effect, trazodone is used to treat sleep disorders as well.
Your patient should avoid driving a car or operating heavy machinery after taking trazodone until he or she understands how it affects him or her. You also suggest that the patient can take it at night if it makes him or her tired. It's also very important that your patient not combine trazodone with any other type of medication even over the counter medications like Benadryl. Combining trazodone with other medications that increase serotonin can result in serious consequences such as serotonin syndrome, in which extremely high serotonin levels can cause fever, diarrhea, and even seizures. Taking trazodone with alcohol or other drugs that make patients sleepy can also have fatal consequences. The combination of drowsiness from the trazodone and alcohol can result in an overdose.
You warn your patient not to stop taking the trazodone suddenly and to check in frequently about any side effects such as fast heart rate, stomach cramps, dry mouth, sweating, or other changes to his or her health. Also, in some patients trazodone has been known to increase suicidal thoughts. It's important for your patient to contact you immediately if there are any drastic changes to his or her mood.
Why Else Do Doctors Prescribe Trazodone?
Although trazodone is a medication for depression, there are also other off-label uses for trazodone, where a doctor uses his or her discretion to prescribe medications for purposes other than their primary use. Trazodone can be used to treat bulimia, anxiety disorders, fibromyalgia, and some dementias.
Bulimia is an eating disorder in which patients binge on food and then purge it by throwing up or using laxatives. Eating disorders are notoriously hard to treat, but trazodone is one option for treatment. In one study, trazodone significantly decreased the occurrence of binge-purge episodes and decreased cravings for carbohydrates. Patients experienced only minimal side effects and did not gain weight, unlike other antidepressants.
There are many options for treating anxiety disorders, and since trazodone has a lot of side effects, it's not often considered a first choice of treatment. However, it has been shown to improve the occurrence of panic attacks and general anxiety in some patients.
Fibromyalgia is a neurological disorder in which patients experience more pain than normal, even without painful stimuli. Some patients respond well to high doses of trazodone to alleviate pain and improve the quality of their sleep. However, an increased, irregular heartbeat is a common side effect and should be monitored closely by the doctor.
Lastly, trazodone is sometimes used to treat dementia, a condition where brain tissue starts to die, usually in older patients, such as Alzheimer's disease. People with dementia experience forgetfulness and eventually extremely erratic behavior like getting up at night and wandering away from home. This causes increased stress on caregivers. Trazodone can be used as a sleep aid in these patients, which not only improves their sleep, but also prevents erratic night behavior. Trazodone can also be used to improve sleep quality in other patients as well, not just those with dementia.
Trazodone is an anti-depressant that increases levels of serotonin in patients. This can alleviate some depression symptoms and can also improve the quality of sleep since it causes drowsiness. There are important side effects to monitor when taking trazodone such as drowsiness, changes in mood, and changes in physical health. Trazodone can also be used to treat other disorders off-label, such as bulimia, anxiety, fibromyalgia, and sleep problems during dementia.
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