Trazodone for Insomnia: Why it's Used? Are there withdrawal symptoms?
Trazodone is a prescription medication that belongs to a class of drugs called serotonin modulators. It is mainly used to treat depression, but it can also be used off-label to treat insomnia, which is a condition of having difficulty falling asleep or staying asleep.
History
Trazodone was first developed in Italy in the 1960s as an antidepressant. It was introduced in the United States in 1981 under the brand name Desyrel. Since then, it has been marketed under various other names, such as Oleptro, Trittico, and Molipaxin. Trazodone is now available as a generic drug.
Mechanism of Action
Trazodone works by affecting the activity of certain chemicals in the brain called neurotransmitters. It increases the level of serotonin, which is a neurotransmitter that regulates mood, sleep, appetite, and other functions. It also blocks the action of histamine, which is a neurotransmitter that promotes wakefulness and alertness. By doing so, trazodone can help improve mood and induce sleepiness.
Evidence for use
Trazodone has been shown to be effective in treating depression in several clinical trials. However, the evidence for its use as a sleep aid is less conclusive. Some studies have found that trazodone can improve sleep quality and duration in people with insomnia, especially those who also have depression 1 2. Other studies have found that trazodone has little or no effect on sleep compared to placebo or other medications 3 4. The American Academy of Sleep Medicine does not recommend trazodone as a first-line treatment for insomnia, due to the lack of strong evidence and the potential risks and harms 3.
Dosing
The dose of trazodone for insomnia varies depending on the individual’s response and tolerance. The usual dose range is between 25 mg to 100 mg taken at bedtime. Some people may benefit from lower doses, while others may need higher doses. The dose should be adjusted gradually and under the guidance of a doctor. Trazodone should not be stopped abruptly, as this may cause withdrawal symptoms.
Side Effects/ Adverse reactions / Contraindications
Trazodone can cause various side effects, such as:
- Drowsiness
- Dizziness
- Headache
- Dry mouth
- Nausea
- Constipation
- Blurred vision
- Low blood pressure
- Priapism (a prolonged and painful erection)
- Serotonin syndrome (a rare but serious condition caused by excess serotonin in the brain)
Trazodone can also interact with other drugs, such as:
- Alcohol
- Antidepressants
- Antihistamines
- Antifungals
- Antibiotics
- Blood thinners
- Seizure medications
- Sleeping pills
Trazodone should not be used by people who have:
- Allergy to trazodone or any of its ingredients
- Heart problems or recent heart attack
- Bipolar disorder or manic episodes
- Liver or kidney disease
- Low sodium levels in the blood
- Pregnant or breastfeeding women
Positives or Pros
Some of the advantages of trazodone for insomnia are:
- It is inexpensive and widely available as a generic drug.
- It is not addictive and does not cause dependence or tolerance.
- It may help people who have both depression and insomnia.
- It may improve deep sleep and reduce nighttime awakenings.
Negatives or Cons
Some of the disadvantages of trazodone for insomnia are:
- It has not been approved by the FDA for this purpose and its efficacy is questionable.
- It can cause many side effects and drug interactions that may outweigh its benefits.
- It can increase the risk of suicidal thoughts and behaviors in young adults and children.
- It can cause priapism, which is a medical emergency that requires immediate attention.
Conclusion
Trazodone is a medication that can be used to treat depression and insomnia, but it is not without risks and limitations. It should be used with caution and under the supervision of a doctor. It should not be considered as a first-choice treatment for insomnia, unless other options have failed or are contraindicated. People who take trazodone should monitor their symptoms and report any changes or concerns to their doctor.
Sources
1: Trazodone for Sleep: Dosage, Benefits, Side Effects & Other Risks - Healthline.com
2: Considerations Before Taking Trazodone for Insomnia - Verywellhealth.com
3: Should You Take Trazodone for Insomnia? - Consumerreports.org
4: Will trazodone help me sleep? - Drugs.com
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Valproic Acid: Your Key to Stability in Bipolar Disorder
What is Valproic Acid?
Valproic acid is a medication that belongs to the class of anticonvulsants or antiepileptics. It is used to treat various conditions, such as seizures, migraine headaches, and bipolar disorder. In bipolar disorder, valproic acid is prescribed as a mood stabilizer, which means it helps to prevent or reduce the severity of manic or depressive episodes¹².
History of Valproic Acid
Valproic acid was first synthesized in 1882 by a German chemist named Adolf von Baeyer, but it was not until the 1960s that its anticonvulsant properties were discovered by French researchers. Valproic acid was initially used to treat epilepsy, but later it was found to have mood stabilizing effects in patients with bipolar disorder. Valproic acid was approved by the U.S. Food and Drug Administration in 1978 and is still considered an effective mood stabilizer. It is available in different forms and names, such as valproate, divalproex sodium, Depakote, and Depakene³ .
Mechanism of Action for Valproic Acid
The exact mechanism of action of valproic acid is not fully understood, but it is believed to involve several effects on the brain. One of them is increasing the levels of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits the activity of nerve cells and reduces excitability. Another effect is blocking the activity of sodium channels, which are involved in transmitting electrical signals between nerve cells. Valproic acid may also affect other neurotransmitters, such as glutamate, serotonin, and dopamine, which are involved in mood regulation¹².
Evidence for use
Valproic acid has been shown to be effective in treating acute mania and preventing relapse in bipolar disorder. Several clinical trials have compared valproic acid with placebo or other mood stabilizers, such as lithium or carbamazepine, and found that valproic acid was superior or comparable in reducing manic symptoms and improving overall functioning. Valproic acid may also have some benefits over other mood stabilizers, such as fewer drug interactions, lower risk of thyroid problems, and better tolerability in some patients¹².
Dosing for Valproic Acid
The dosing of valproic acid depends on several factors, such as the condition being treated, the patient's age, weight, liver function, and response to treatment. Valproic acid is available in different forms, such as tablets, capsules, or oral solution. The tablets and capsules can be swallowed whole or sprinkled on soft food. The oral solution can be mixed with water or juice. The usual starting dose for bipolar disorder is 750 mg per day, divided into two or three doses. The dose may be increased gradually until the desired effect is achieved or the maximum dose of 60 mg per kg per day is reached. The dose may need to be adjusted periodically based on blood tests that measure the level of valproic acid in the body¹².
Side Effects/ Adverse reactions / Contraindications
Valproic acid can cause various side effects, some of which are mild and transient, while others are serious and potentially life-threatening. The most common side effects include nausea, vomiting, diarrhea, constipation, abdominal pain, loss of appetite, weight gain or loss, drowsiness, dizziness, tremor, headache, hair loss, blurred vision, and changes in menstrual cycle. The most serious side effects include liver damage, pancreatitis, bleeding problems, low platelet count, high ammonia levels in the blood, encephalopathy (brain dysfunction), suicidal thoughts or behaviors, birth defects in pregnant women or women who become pregnant while taking valproic acid, and hypersensitivity reactions (such as rash, fever, swelling). Valproic acid is contraindicated in patients who have a history of allergic reaction to valproic acid or any of its components; liver disease; urea cycle disorders; mitochondrial disorders; or porphyria (a rare blood disorder). Valproic acid should also be avoided by women who are pregnant or planning to become pregnant unless there is no alternative treatment available¹².
Positives or Pros of Valproic Acid
Valproic acid has several advantages as a mood stabilizer for bipolar disorder. Some of them are:
- It has a broad spectrum of action that covers both manic and depressive phases of bipolar disorder.
- It has a rapid onset of action that can provide relief from acute mania within days.
- It has a low potential for drug interactions compared with other mood stabilizers.
- It has a lower risk of causing thyroid problems, kidney problems, or diabetes than lithium.
- It may be better tolerated by some patients who experience side effects from other mood stabilizers.
Negatives or Cons of Valproic Acid
Valproic acid also has some disadvantages as a mood stabilizer for bipolar disorder. Some of them are:
- It can cause serious and sometimes fatal side effects that require careful monitoring and management.
- It requires regular blood tests to monitor the level of valproic acid in the body and the liver function.
- It can cause weight gain, which may increase the risk of obesity, cardiovascular disease, and metabolic syndrome.
- It can cause cognitive impairment, such as memory loss, confusion, and difficulty concentrating.
- It may not be as effective as lithium in preventing suicidal behavior in bipolar disorder.
Conclusion
Valproic acid is a medication that can be used as a mood stabilizer for bipolar disorder. It works by affecting various neurotransmitters and channels in the brain that regulate mood. It has been proven to be effective in treating acute mania and preventing relapse in bipolar disorder. However, it also has some serious side effects that require careful monitoring and management. Valproic acid may not be suitable for everyone and should be used with caution and under the guidance of a doctor.
Sources:
¹: Valproate (Depakote) | NAMI: National Alliance on Mental Illness
²: Mood Stabilizers List - Healthline
³: Introduction to Mood Stabilizers and Anticonvulsants - PsychDB
Additional Sources:
(1) Valproate (Depakote) | NAMI: National Alliance on Mental Illness. https://nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Valproate-%28Depakote%29.
(2) Mood Stabilizers List - Healthline. https://www.healthline.com/health/mood-stabilizers-list.
(3) Introduction to Mood Stabilizers and Anticonvulsants - PsychDB. https://www.psychdb.com/meds/mood-stabilizers-anticonvulsants/home.
(4) The Benefits and Risks of Mood Stabilizers for BPD - Verywell Mind. https://www.verywellmind.com/mood-stabilizers-for-bpd-are-they-effective-425460.
By Birk Gundersen, RN, BSN.
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