Is Trazodone an Effective Hypnotic?

By Dr. Gregg D. Jacobs
November 17, 2004

In recent years, primary care physicians and sleep physicians have increasingly prescribed low-dose sedating antidepressants such as trazodone for insomnia. Indeed, the last few years have seen a remarkable rise in the off-label use of trazodone for inducing sleep in non-depressed patients, to a degree that it is prescribed for this purpose as commonly as the leading hypnotic . Although trazodone has fewer potential side effects in some respects than benzodiazepine hypnotics (trazodone does not disturb sleep architecture and is not associated with tolerance or dependence), it has more serious potential side effects for induction of arrhythmias, primarily in patients with histories of cardiac disease. Additionally, few studies have been conducted that have evaluated its safety or efficacy in the treatment of insomnia.

In a recent issue of the Journal of Clinical Psychiatry (2004, 65:752-5), Drs. S. James and W. Mendelson reviewed the existing scientific literature on the use of trazodone for insomnia. From this review, these authors concluded that there are "very few data to suggest that trazodone improves sleep in patients without mood disorder, though it does increase total sleep in patients with major depressive disorder". The authors also point out that there is little available data on tolerance to its possible hypnotic effects.

In summary, there are few data to support the use of trazodone in non-depressed subjects. These findings suggest that non-benzodiazepine hypnotics such as Ambien are the most appropriate choice of a sedative-hypnotic in non-depressed insomnia when a hypnotic is indicated (e.g., transient or short-term insomnia, intermittent use in the 25% of chronic insomniacs who do not respond to cognitive-behavioral therapy, or jet lag).