If you’ve heard of trazodone being used for anxiety, you’re not alone. Trazodone is a prescription medication primarily approved to treat depression, but many clinicians prescribe it “off-label” for anxiety and sleep problems. People ask whether it actually reduces anxiety or simply helps with sleep which secondarily reduces anxious feelings. At Portland Treatment in Biddeford, …
If you’ve heard of trazodone being used for anxiety, you’re not alone. Trazodone is a prescription medication primarily approved to treat depression, but many clinicians prescribe it “off-label” for anxiety and sleep problems. People ask whether it actually reduces anxiety or simply helps with sleep which secondarily reduces anxious feelings.
At Portland Treatment in Biddeford, Maine, we help people understand how medications like trazodone can fit into comprehensive care for co-occurring anxiety and mood symptoms.
What Trazodone Is and How It Works
Trazodone is an antidepressant in the class known as serotonin antagonists and reuptake inhibitors (SARIs). It affects serotonin, a key neurotransmitter involved in mood regulation, and also influences other brain systems that affect sleep, agitation, and anxiety.
Although approved by the U.S. Food and Drug Administration (FDA) for major depressive disorder, trazodone is frequently prescribed off-label for conditions such as anxiety disorders and sleep disturbances linked with anxiety or depression.
What the Evidence Shows About Trazodone and Anxiety
Anxiety Relief Through Mood Regulation
Clinical evidence supports that trazodone has anxiolytic properties, meaning it can reduce anxiety symptoms, especially when anxiety occurs alongside depression. Some studies suggest trazodone’s effects on serotonin may help reduce generalized anxiety symptoms.
Sedation and Sleep Improvements Can Reduce Anxiety
Trazodone’s sedating effect, related to how it interacts with serotonin, histamine, and other receptors, is one reason it may be useful when anxiety interferes with sleep. Improved sleep often helps reduce overall anxiety levels.
Not A First-Line Anxiety Medication
While trazodone can help some people, it’s not typically the first choice for anxiety alone. Other medications like SSRIs or SNRIs and therapy are standard first-line treatments for anxiety disorders. Trazodone is often chosen when a person also has insomnia or when other anxiety medications haven’t worked well.
How Trazodone May Be Used in Anxiety Treatment
Here are some common ways trazodone is used related to anxiety:
- When anxiety and insomnia occur together: Trazodone’s sedative effects can help improve sleep habits, which can reduce daytime anxiety.
- As a secondary agent when primary anxiolytics aren’t suitable: Clinicians sometimes use trazodone if a person cannot tolerate typical anxiety medications.
- In combination with therapy and other supports: Medication alone rarely fully resolves anxiety, it’s most effective as part of a broader treatment plan.
Limitations and Risks
Off-label Use and Limited Data
The use of trazodone for anxiety is considered off-label, meaning it’s not formally approved by the FDA for this purpose, and evidence is limited compared to first-line anxiety medications.
Side Effects and Safety
Trazodone can cause side effects such as:
- Drowsiness
- Dizziness
- Dry mouth
- Headache
- Irritability or restlessness
- Unusual thoughts or mood changes
Serious but rare risks can include serotonin syndrome, especially if combined with other serotonin-affecting medications. Always discuss side effects with a clinician.
Who Might Benefit Most
Trazodone might be particularly useful if:
- Anxiety is interfering with sleep
- Depression and anxiety coexist
- Typical anxiety medications aren’t tolerated
- A clinician recommends it as part of a comprehensive plan
It may be less helpful if anxiety occurs without sleep disruption or without depressive features.
How Portland Treatment Approaches Anxiety and Medication
At Portland Treatment, medication decisions, including the use of trazodone, are made as part of an individualized plan. This plan can include:
- Psychiatric evaluation
- Detox from Prescription Drug Dependence
- Therapy (CBT or DBT)
- Medication education
- Support for insomnia as part of anxiety relief
Medication is rarely used in isolation, we integrate it with therapy and other tools to build lasting coping skills.
Takeaway
Trazodone can help some people with anxiety, particularly when anxiety affects sleep or occurs with depression. It is not a first-line anxiety medication, but when prescribed thoughtfully and monitored closely, it may be a valuable part of a broader treatment plan.
As with all medications, decisions should be made with a clinician who understands your full health history and current symptoms.
Frequently Asked Questions about Trazodone for Anxiety
Is trazodone approved to treat anxiety?
No. Trazodone is FDA-approved for depression, but it is commonly used off-label for anxiety, especially when sleep problems are present.
How does trazodone help anxiety?
It affects serotonin and other chemical messengers in the brain, which can reduce mood symptoms and improve sleep, both of which can indirectly reduce anxiety.
Does trazodone make anxiety worse?
In some cases, trazodone can cause restlessness or increased anxiety, especially when first starting or if dosage is too high. Discuss any worsening symptoms with your clinician.
Can trazodone replace therapy for anxiety?
Medication like trazodone may help symptoms, but therapy (such as cognitive behavioral therapy) remains a central evidence-based treatment for anxiety.
How long does it take trazodone to work?
It may take several weeks for mood effects to stabilize, but sedating effects on sleep may be noticeable earlier. Always follow your clinician’s guidance.
Sources
- Bossini, L. (2015). Off-label trazodone prescription: Evidence, benefits and other uses. PubMed. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26088119/
- Cuomo, A. (2021). Trazodone: A multifunctional antidepressant. Journal of Gerontology and Geriatrics. Retrieved from https://www.jgerontology-geriatrics.com/article/view/320
- National Health Service. (n.d.). About trazodone. NHS.uk. Retrieved from https://www.nhs.uk/medicines/trazodone/about-trazodone/
- Shin, J. J. (2024). Trazodone. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470560/
- Healthline. (2019). Trazodone for anxiety: Is it effective? Retrieved from https://www.healthline.com/health/mental-health/trazodone-for-anxiety
- National Health Service. (n.d.). Common questions about trazodone. Retrieved from https://www.nhs.uk/medicines/trazodone/common-questions-about-trazodone/
- Mayo Clinic. (n.d.). Atypical antidepressants. Retrieved from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/atypical-antidepressants/art-20048208
- WebMD. (2024). Trazodone: Uses, side effects, interactions. Retrieved from https://www.webmd.com/drugs/2/drug-11188/trazodone-oral/details
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John Ingham
John Ingham is a respected leader and medical content writer specializing in behavioral health, addiction treatment, and other mental health. With more than a decade of experience in the recovery and treatment field, his work has been featured across leading treatment networks and educational platforms, and has contributed as a lecturer in graduate level seminars within the Steve Hicks School of Social Work at University of Texas at Austin, and undergraduate seminars at Vanderbilt University. John's work has also been recognized in public service announcements, documentaries and more, including a feature that won an Emmy Award. John has collaborated with presidential appointees in the White House, clinicians, program directors, and other leaders throughout the behavioral health space, further establishing his role as a trusted voice in the field.
