Trazodone: What It Is, How It Works, and What You Need to Know

When you hear trazodone, a serotonin modulator used primarily for depression and sleep issues. Also known as Desyrel, it's one of the most prescribed off-label sleep aids in the U.S.—but it’s not just a sleeping pill. Unlike benzodiazepines, trazodone doesn’t cause dependence, which is why doctors reach for it when anxiety or insomnia comes with depression. But it’s not harmless. People often take it without knowing how it affects their blood pressure, heart rhythm, or even their next-day focus.

Trazodone works by boosting serotonin in the brain, but it also blocks certain receptors that keep you alert. That’s why it makes you drowsy—sometimes within 30 minutes. But that same mechanism can cause orthostatic hypotension, a sudden drop in blood pressure when standing up, leading to dizziness or falls, especially in older adults. It’s also linked to serotonin syndrome, a dangerous reaction when combined with other serotonin-boosting drugs like SSRIs or SNRIs. If you’re on fluoxetine, venlafaxine, or even St. John’s wort, mixing them with trazodone can be risky. And while it’s often used for sleep, studies show it doesn’t improve sleep quality long-term—just helps you fall asleep faster.

Many people switch to trazodone because they can’t tolerate the sexual side effects of SSRIs. But trazodone has its own trade-offs: dry mouth, headaches, nausea, and in rare cases, abnormal heart rhythms. If you’re over 65, have heart disease, or take other meds that affect your liver, your doctor should check your EKG before prescribing it. And if you’ve ever had a reaction to antidepressants before, don’t assume trazodone is safer—just different.

Below, you’ll find real-world advice from people who’ve used trazodone—what worked, what didn’t, and what they wish they’d known before starting. From timing doses to spotting early warning signs of side effects, these posts give you the practical details no pharmacy handout ever covers.