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Trazodone Tapering

Last Updated on December 28, 2023 by Carol Gillette

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

Alternative to Meds Center knows how important it is to seek competent medical oversight & guidance to maneuver trazodone tapering, titration, and weaning in an exacting, slow and gentle way.

Side effects and reactions when discontinuing antidepressants such as trazodone, even after indisputable evidence regarding these complications, still tend to be largely misunderstood in outpatient settings. There just isn’t the oversight necessary to properly guide the process.

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Trazodone Tapering — Challenges

Challenges of trazodone tapering and withdrawal are due in no small part to the fact that the medication itself is not completely understood. Fagiolini et al’s extensive article, (over 8,000 words long) “Rediscovering Trazodone for the Treatment of MDD” published in the Journal of CNS Drugs includes over 100 references to other papers and clinical studies in top-tier medical publications and concludes that the mechanism(s) are just not understood.11 While it has been postulated that antidepressant drugs alter/manipulate certain brain chemicals and change how neurochemistry functions, these changes have not been fully mapped out. What the authors say is that trazodone has a unique pharmacologic profile, unlike any other antidepressant.

Another known fact is that trazodone has the most sedating effect of all atypical antidepressants.9 For this reason, it is sometimes prescribed where sleep but not depression is the focus of treatment. There are no formal restrictions on prescribing trazodone in the elderly population, or for insomnia, but there are restrictions due to the increased risk of suicide in the young. In the elderly population, trazodone is thought linked to Parkinsonism, according to a case study published in the Journal of Clinical Neuropharmacology. This study cites an elderly non-depressed patient who rapidly developed Parkinsonism after being prescribed trazodone. Thankfully a second doctor realized the symptoms could be trazodone-related, and the condition completely reversed when trazodone was withdrawn.9

It is postulated that neurochemical changes can create symptoms. Withdrawing the drug may further tax the already drug-impaired brain chemistry and the CNS as a whole. Another factor to consider is the short half-lives of the drug’s compound elements, as well as a possible rebound of certain excitatory transmitters and hormones.1,13 A person may have also suffered from pre-drug conditions that were overlooked that still need to be resolved.

The backlash of these reactions can be hard to tolerate, let alone sort out, especially where no proper preparations or careful oversight have occurred. Maund et al published a study in the 2019 Annals of Family Medicine where the authors conclude that many patients would probably not have decided on antidepressant treatment in the first place had they been thoroughly informed of what to expect during withdrawal.12 It helps if the person has been informed of at least some of what to expect during the trazodone titration process.

When to Taper Off Trazodone

holistic treatment for depressionIn the midst of a crisis requiring medication, the last thing on someone’s mind is how to taper off the medication. In the rush of desperately seeking help for symptoms of depression, a person does not always have the time or opportunity to research their diagnosis. Nor will a person likely question the prescription that has been recommended, or take time to understand the nature of the drug(s) so prescribed. It is only later that a person might reach a point of considering getting off their medication. That is a good time to research the drug they are taking, how it potentially changes brain chemistry, and to get a better understanding of what type of support could help ease trazodone tapering.

In theory, two main scenarios precede considering trazodone titration. The first is where the treatment was very successful, and the prescribing physician recommends a gradual trazodone cessation because the patient is now well.

Far more commonly, the second situation finds the treatment has not provided the relief that was sought, and any perceived benefits are being canceled out by adverse side effects. Tapering trazodone may present a challenge because of particularly harsh reactions that may emerge while weaning off the drug. The situation can resemble quite a medical puzzle. For safety reasons, it is wisest to seek competent medical oversight and guidance to maneuver through the trazodone tapering process.

Trazodone Discontinuation Syndrome

antidepressant discontinuation syndrome Otani et al studied 3 cases experiencing trazodone withdrawal symptoms despite a gradual reduction of the drug. The authors concluded that trazodone tapering should be done at a very slow pace to soften the withdrawals.1

The trazodone drug label devotes a single sentence to withdrawals, a very brief mention of possible anxiety, agitation, or sleep problems.10

Henssler et al take a closer look at the potential severity of ADS or antidepressant discontinuation syndrome. The Henssler study includes clear evidence of the more harsh and longer-lasting symptoms of antidepressant withdrawal.13

The study reports that a second classification called acute discontinuation syndrome has now emerged as a well-documented addition to the medical literature. These symptoms can last for weeks, months, or years, and are substantially more severe, some even life-threatening. One important aspect of ADS mentioned by the study is rebound symptoms. Rebound symptoms occur when a person’s original conditions reappear (during drug withdrawal) but are worse than before the person started taking medication. This often results in a misdiagnosis that the person has “relapsed” when it is a withdrawal phenomenon.

The list of acute discontinuation symptoms below is not a complete list but is taken in part from Henssler’s review, or otherwise cited:
  • Sensory — paresthesias, electric brain zaps, sensory disorders, itching, blurred vision, altered taste, loss of balance, lightheadedness.11
  • Neuromuscular — muscle tension, myalgia, neuralgia, agitation, ataxia, tremor.
  • Vasomotor — perspiring, chills, flushing, dysregulated body temperature.
  • Gastrointestinal – diarrhea, anorexia, nausea, vomiting, abdominal pain.
  • Sexual — genital hypersensitivity, premature ejaculation.
  • Sleep — insomnia, unusual dreams, nightmares, hypersomnia.
  • Cognitive — confusion, amnesia, unable to focus, disorientation.
  • Psychological — hypomania,14 anxiety, depression, panic, agitation, impulsivity, crying spells, outbursts of anger, mania, delusions, increased suicidal thoughts, derealization, depersonalization, auditory or visual hallucinations.

Trazodone Tapering Guidelines and Schedule

Trazodone tapering inpatient under medical supervision is recommended. One might also consider speaking to friends and family beforehand to let those closest to you know your plans, and to garner understanding and support.

One of the concerns about tapering trazodone is its relatively short half-life. According to the medical literature, trazodone has a redistribution half-life of one hour and a total elimination time of 10 hours.7 Your physician can assist with the management of the dosages, which could involve actually cutting the pills as needed for titrating down.

Trazodone Tapering Guidelines Include:
  • trazodone tapering guidelinesImportant: very slow Trazodone tapering is recommended.1,13
  • Although trazodone is not an SSRI, serotonin syndrome should be watched for, requiring immediate transport to an ER.8
  • Have your prescribing physician prescribe pills in the smallest dose available. In this case, it is 50mg trazodone white round tablets
  • Your doctor may advise you to cut the 50mg pills in half or quarters for smaller dosing. A half pill would be 25mg and a quarter would be 12.5mg.
  • A reduction of 10-25% is a good starting point, adjusted as needed for personal sensitivity.
  • Drug withdrawals will emerge according to the elimination half-life. In this case, the elimination half-life is about 10 hours depending on individual variability.7 Onset of trazodone withdrawal will generally be felt on the day of the medication reduction. The withdrawal duration may last anywhere from days to weeks … sometimes longer as discussed below.
  • Take a flexible approach and adjust dosage according to tolerance, which may change over the course of the titration.
  • Trazodone tapering needs to be very slow, so allow adequate time to settle after each adjustment. This could mean 10 days or several weeks.
  • If the final cuts are problematic, slow the process down to accommodate.

If you are experiencing protracted withdrawal you or your caregiver are welcome to contact us at the center, as an inpatient setting may be better suited to your recovery.

Stopping Trazodone Should Be Done Very Slowly

A Japanese study from 1994 followed a number of patients stopping trazodone and the difficulties they encountered during the process.

The researchers point to a possible rebound effect of certain neurochemicals and hormones (noradrenaline) when the drug is discontinued. They found that even a gradual trazodone titration could still produce considerable adverse reactions. These medical researchers concluded that patients should begin tapering trazodone VERY slowly to mitigate and maybe even prevent these reactions as much as possible.1

But time is not the only factor that can contribute to a successful trazodone tapering program.

Alternative to Meds Center’s World-Class Programs

Getting off trazodone or any drug can present certain difficulties as the body begins to adjust back to a non-medicated state. Understanding as much as we can about the mechanics of how antidepressants affect and change neurochemistry, and what to expect while trying to quit trazodone is vital. This is our specialty and there is no other program like Alternative to Meds anywhere else.

An important and very popular aspect of the programs offered at Alternative to Meds Center is the educational component. Clients are given the opportunity to learn more about alternatives that can enhance healthy brain chemistry and start to improve overall CNS efficiency. Clients are also given tools to help maintain and improve health through dietary and lifestyle changes, and how to better understand the mechanisms of a healthy microbiome and how that relates to brain health, better sleep, more energy, better mood, and many other topics of interest.

Microbiome and Toxic Burden Relief to Assist Trazodone Discontinuation

crucial role of good gut healthOnce the benefits of clearing toxins from the body are well understood it becomes a logical choice because it can support the repair of robust neurochemicals naturally. Education will expand the client’s understanding of what toxins are, exactly, and how they can negatively impact health, and so much more. Using these informational tools, clients can become more confident and able to manage and care for their own health and well-being and may be less likely to feel they must rely on drugs for relief. Trazodone titration doesn’t have to be so intimidating, once the client has acquired the many tools with which one can begin to overcome such difficulties. Clients who have not found success in trying to quit trazodone before now can start to experience the kind of confident, compassionate care that ensures the successful outcome they have been seeking.

Educating a person more about healthy neurochemistry and maintenance of a healthy microbiome before approaching the problems of how to get off trazodone is a bit like showing someone how to drive, in a side-by-side partnership with the student, before handing the keys entirely over.

Testing and Removal of Neurotoxins

Clients are checked over before beginning their trazodone tapering regimen and are shown the results of various lab testing that are done. These tests provide a snapshot of existing accumulations of neurotoxins, chemical residues, industrial pollutants in specific detail, and much more. These neurotoxins can be gently removed from the body using various methods such as supplements to facilitate holistic detox combined with sauna, bentonite clay, mineral baths, nebulized glutathione, ionic foot baths, IV infusions, and other gentle methods. Neurotoxin removal can be a wonderful enhancement so that stopping trazodone will be less prone to harsh side effects that may otherwise present where the person’s neurochemistry was compromised or overburdened.

Many other therapies are provided during the process of stopping trazodone which can actually help to speed up the process and help reduce or even eliminate discomforts.

Trazodone is a SARI-Type Medication — What Does That Mean?

antidepressant serotonin deficiencyTrazodone is classed as a SARI antidepressant. The letters stand for serotonin, agonist, reuptake, and inhibitor. SARI drugs are thought to be very similar to SSRI drugs, the serotonin reuptake inhibitor type antidepressants. Despite the details suggested by these classifications, no one seems to have a definitive answer to exactly how these drugs work. In theory, trazodone causes certain natural chemicals (i.e., serotonin) to remain suspended along the CNS, not able to be reabsorbed for later use. The drug is thought to block these molecules (and possibly others) so they begin to pool or build up. It is thought that this build-up is what chemically lifts the depression, causes drowsiness, or causes other reactions that may occur.

However, over time, suspended molecules eventually degrade & become inert. They become waste material and are lost. Since trazodone or any other drug does not create serotonin or any other neurochemical, it is probable that this blockage ultimately results in a deficit. The drug would create a shortage of the very chemicals that were theoretically needed to reduce the person’s symptoms. This theory seems congruent with a person who may begin to find that these drugs “aren’t working anymore” or the person’s depression has worsened, or other unusual side effects begin to appear. This outcome can overshadow any positive results that were initially perceived from the drug therapy.

Trazodone Tapering and Insomnia

More prescriptions of trazodone are actually written for insomnia than for depression.5 Where trazodone was prescribed for insomnia the person’s insomnia might re-emerge during the course of taking the drug, and may become more troublesome than it was before the drug was started. There are published research findings that as of this writing do not recommend trazodone for chronic insomnia, in contrast to the frequency that doctors prescribe the drug for this condition.2 Thankfully, there are non-drug-based ways used at Alternative to Meds Center designed to improve sleep. And, they work. If a person was prescribed trazodone for insomnia, now may be the time to consider other non-toxic methods to resolve sleep issues.4 Alternative to Meds specializes in these types of treatments.

Importance of Nutrition and Diet During Trazodone Titration

improve nutrition for antidepressant taperingIt is well established that a correct diet, with complete supplementation, can have a lot to do with symptoms of depression, and is a powerful tool to use in treatment.3

To assist the body to rebuild robust neurochemistry, diet can be one of the most powerful recovery tools. Using organic, nutrient-rich foods, and dietary guidelines designed to correct certain deficiencies that a client’s lab testing may have indicated, diet can be important in successfully getting off trazodone and doing it as comfortably and gently as possible.

Certain conditions such as insomnia, anxiety, headaches, addiction, and others can be eased with dietary and targeted nutritional support. Where indicated, food and other allergy testing can be revelatory and can be life-changing. Removal of toxic accumulations is a necessity. A clean diet includes foods that are mostly organic, free from pesticides, free from preservatives, contain low to no sugar or refined carbs, and are full of bioavailable nutrients. Supporting the gut (microbiome) with fermented foods and other supplements is vital for natural mental health. Amino and other IV treatments are highly beneficial for natural mental health. There are many more services that Alternative to Meds Center provides, which you can access more information on by checking out the services page.

Contact Alternative to Meds Center for Trazodone Tapering Help

In summary, the Alternative to Meds Center inpatient programs take a holistic approach seeking to address all areas that can improve health and especially support healthy neurochemistry.

Please contact us at Alternative to Meds Center and find out more about how the goal of achieving natural mental health has been built in at the core of our safe and gentle inpatient trazodone tapering programs.

1 (800) 301-3753 for Trazodone Tapering Help

Sources:

1. Otani K et al., “Mechanisms of the development of trazodone withdrawal symptoms” NIMH, 1994 US National Library of Medicine [cited 2022 July 6]

2. Sateia MJ et al., “Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline” 15 Year Anniversary Edition of the Journal of Clinical Sleep Medicine, 2017 Feb 15 [cited 2022 July 6]

3. Berk M MD, Jacka FN PhD “Diet and Depression – From Confirmation to Implementation” editorial, JAMA, 2019 Mar 5, [cited 2022 July 6]

4. Edlund M J, “Is Trazodone the New Brain Wonder Drug?” Psychology Today [Internet] 2017 Apr 22 [cited 2022 July 6]

5. Jaffer K Y, Chang T, et al., “Trazodone for Insomnia: A Systemic Review.” Innovations in Clinical Neuroscience [Internet] 2017 Jul-Aug[cited 2022 July 6]

6. FDA Access Data OLEPTRO (trazodone hydrochloride) extended-release tablets [cited 2022 July 6]

7. Bryant SG, Ereshefsky L. Antidepressant properties of trazodone. Clin Pharm. 1982 Sep-Oct;1(5):406-17. PMID: 6764164. [cited 2022 July 6]

8. Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin syndrome. Ochsner J. 2013;13(4):533-540. [cited 2022 July 6]

9. Sarwar AI. Trazodone and Parkinsonism: The Link Strengthens. Clin Neuropharmacol. 2018 May/Jun;41(3):106-108. doi: 10.1097/WNF.0000000000000278. PMID: 29634584. [cited 2022 July 6]

10. FDA Drug Label DESYREL (trazodone hydrochloride) tablets. [approval 1981] [cited 2022 July 6]

11. Fagiolini A, Comandini A, Catena Dell’Osso M, Kasper S. Rediscovering trazodone for the treatment of major depressive disorder [published correction appears in CNS Drugs. 2013 Aug;27(8):677]. CNS Drugs. 2012;26(12):1033-1049. doi:10.1007/s40263-012-0010-5 [cited 2022 July 6]

12. Maund E, Stuart B, Moore M, et al. Managing Antidepressant Discontinuation: A Systematic Review. Ann Fam Med. 2019;17(1):52-60. doi:10.1370/afm.2336 [cited 2022 July 6]

13. Henssler J, Heinz A, Brandt L, Bschor T. Antidepressant Withdrawal and Rebound Phenomena. Dtsch Arztebl Int. 2019;116(20):355-361. doi:10.3238/arztebl.2019.0355 [cited 2022 July 6]

14. Jabeen S, Fisher CJ. Trazodone-induced transient hypomanic symptoms and their management. Br J Psychiatry. 1991 Feb;158:275-8. doi: 10.1192/bjp.158.2.275. PMID: 2012922. [cited 2022 July 6]

Originally Published Nov 3, 2019 by Lyle Murphy, Founder


This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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