Trazodone is an antidepressant that is widely used off-label for insomnia, and the research suggests it can help at low doses, though the evidence is small and mixed. A 2017 systematic review of 45 studies found its efficacy repeatedly demonstrated for insomnia, [jaffer-2017] while a 2022 network meta-analysis listed it among licensed drugs that can be effective in acute insomnia but are poorly tolerated or lack long-term data. [decrescenzo-2022-trazodone] This guide covers what the studies found, how trazodone compares with CBT for insomnia, what they could not show and what to ask a prescriber. Our guide to sleeping pills covers the other drugs, and our sleep overview covers the wider picture.
Does trazodone work for sleep?
The studies suggest it can, with limits on how firmly. The 2017 review searched 1983 to 2016 and included 45 studies of randomised trials, meta-analyses and observational and placebo-controlled studies of trazodone for primary or secondary insomnia. It found that evidence for efficacy has been repeatedly demonstrated for primary insomnia and for secondary insomnia, including symptoms resulting from depression and dementia. [jaffer-2017]
The reviewers concluded that adequate data support the efficacy and general safety of low-dose trazodone for insomnia. [jaffer-2017] The weakness is the mix: 45 studies across designs, going back decades, is not the same as one large modern trial.
The 2022 network meta-analysis, which compared drugs across 154 double-blind trials, took a more cautious line. Its interpretation was that many licensed drugs, including benzodiazepines, daridorexant, suvorexant and trazodone, can be effective in the acute treatment of insomnia but are associated with poor tolerability, or that information about long-term effects is not available. [decrescenzo-2022-trazodone]
Why is an antidepressant prescribed for sleep?
Because drowsiness is its most common side-effect, and it has been used off-label for years. Trazodone is approved for the treatment of depression, and the 2017 review noted that its off-label use for insomnia has surpassed its use as an antidepressant. [jaffer-2017]
Earlier studies from 1980 to 2000 used high doses of 100 mg a day or more in depressed people. Since the 2000s its use has widened to secondary insomnia in people who are not depressed, and the reviewers’ conclusion concerns low-dose use. [jaffer-2017]
What are the side-effects of trazodone for sleep?
They depend on the dose, and drowsiness is the most common. The 2017 review reported that side-effects are dose-dependent and concluded that low-dose use is generally safe on the available evidence. [jaffer-2017] That is a statement about a low dose in the studies reviewed, so what is right for you is a decision for a prescriber who knows your other medicines.
How does trazodone compare with CBT for insomnia?
A small trial found trazodone lengthened sleep more, in one specific group. It randomised 15 adults with chronic insomnia who also had objectively short sleep, 8 to CBT-I and 7 to trazodone, and measured sleep with wrist actigraphy. Trazodone, but not CBT-I, lengthened total sleep time after treatment (by 51.01 minutes versus a fall of 11.73 minutes, a difference that just missed the usual threshold for statistical significance) and at 6-month follow-up (by 50.35 minutes versus a fall of 7.56, which did reach it). [vgontzas-2020]
There were no differences between the groups on the Insomnia Severity Index, a self-rated score. The authors described the trial as preliminary and open-label, which means everyone knew which treatment they were getting, and the numbers are small. [vgontzas-2020] It tells you a drug and a talking therapy can work differently in one phenotype, and it does not show that either is better overall. Our guide to CBT for insomnia explains the behavioural treatment.
Questions worth taking to a prescriber
Tick anything that applies. This is a preparation prompt for a conversation about sleep medication, it cannot diagnose anything and it does not say whether trazodone is right for you.
0 of 6 ticked
Several of these affect which sleep medicine, if any, is sensible. Bring the list to your appointment.
Enough here to be worth describing to a prescriber, including what else you take and how alcohol fits in.
None of these stands out as a reason to raise medicine first. If sleep is still a problem, start with habits and a conversation with a doctor.
The screener is a short self-check, not a diagnosis, and neither it nor this list tells you whether to take a medicine.
| Question | What the studies found | Caveat |
|---|---|---|
| Does it work? | Efficacy repeatedly demonstrated in 45 studies | Mixed designs, mostly older |
| Compared with CBT-I? | Longer sleep with trazodone in 15 people | Preliminary, open-label |
| Side-effects? | Dose-dependent, drowsiness most common | Low-dose focus |
| Long term? | Information not available (2022 review) | Unknown |
What can this research not show?
It cannot show which dose is right, how long to take it or whether it suits you. Five limits matter most:
- The main review mixes study designs. Its 45 studies include observational work and span 1983 to 2016, so it is not a single controlled trial. [jaffer-2017]
- The comparison with CBT-I is tiny. Fifteen people, open-label and preliminary, in one phenotype of insomnia. [vgontzas-2020]
- Long-term effects are unknown. The 2022 review said information on long-term effects was not available for several drugs, trazodone among them. [decrescenzo-2022-trazodone]
- Side-effects are only partly described. We could verify that they are dose-dependent and that drowsiness is the most common, but not the full list or the interaction with other medicines. [jaffer-2017]
- Averages hide individuals. Nothing here tells you how you will respond, and older adults, people on other medicines and people who drink were not the focus.
What should you ask a prescriber?
Ask what dose is planned and why, how long to take it, what the plan is for stopping and whether a course of CBT for insomnia can start first or alongside. This section is our suggestion and is not something the studies tested.
Useful questions are what to do about alcohol and other medicines, how it might affect driving the next day and what to do if it does not help. Our guides to sleeping pills, why you cannot sleep and sleep hygiene cover the surrounding options. Do not stop a prescribed sleep medicine suddenly without speaking to the prescriber.
When to seek help
Speak to a doctor if poor sleep has lasted three weeks or more, if it is affecting your days or mood, or if you are already taking trazodone and want to stop, or are having daytime drowsiness or side-effects. If you feel unable to stay safe, contact your local emergency services or a crisis helpline.
How MyFreud can help
A sleep record helps a prescriber more than a description from memory. Daily mood tracking in MyFreud shows how your days run over weeks, and the notepad is somewhere to note when you slept, what you took and how you felt the next day. It does not replace a doctor.
Download MyFreud and start today: App Store or Google Play.