Does trazodone cause mood swings? (3 tips)

This article will explore the topic of mood swings induced by trazodone. It will discuss the occurrence and factors influencing these mood swings, the mechanisms through which trazodone may cause them, and the research findings on this subject. 

Additionally, the article will provide recommendations on how to manage trazodone-induced mood swings.

Does trazodone cause mood swings?

Yes, trazodone may cause mood swings in certain individuals. However,  mood swings are not commonly reported as a side effect of trazodone, and they are reported by a small percentage of patients using the drug. 

These mood swings can manifest as shifts towards hypomania or manic states, and their occurrence is heavily influenced by the patient’s existing mental health condition.

The FDA specifically advises against the use of trazodone in individuals with bipolar disorder and recommends screening for personal and family histories of the disorder to minimize the risk of mood swings and switches to hypomania or mania while taking trazodone.

However, medication responses vary from person to person, and not everyone will experience trazodone-related mood swings. Furthermore, the severity and intensity of mood swings can differ among those who do experience them.

Thus, it is crucial to communicate any changes in mood or overall well-being to your healthcare provider.

How can trazodone cause mood swings?

Mood swings cause people to suddenly experience a depressive mood followed by an elevated or irritable mood, or vice versa. Mood swings are often caused by a dysregulation of neurotransmitters such as serotonin, norepinephrine, and dopamine in the brain.

Trazodone is classified as a serotonin antagonist and reuptake inhibitor (SARI). This means that it acts on the serotonin system in the brain through several mechanisms. Firstly, trazodone inhibits the serotonin transporter, preventing the reuptake of serotonin into presynaptic neurons.

Moreover, it blocks serotonin type 2 receptors. It also blocks histamine and alpha-1-adrenergic receptors. At low doses, trazodone’s inhibition of serotonin type 2 receptors and noradrenergic receptors predominates.

However, at high doses, trazodone’s inhibition of serotonin reuptake predominates, leading to increased levels of serotonin in the brain.

This increase in serotonin may contribute to its antidepressant effects. These complex and mixed effects on the serotonin system can increase the risk of the occurrence of trazodone-induced mood swings.

What does research suggest?

A review examined seventeen case reports investigating mood switching associated with the use of trazodone. In these cases, patients took various doses of trazodone, ranging from 50 to 400 mg per day, and still experienced mood switching to hypomania or mania. 

The majority of the cases involved patients who experienced mood swings when they were taking higher doses of trazodone, specifically in the range of 300–400 mg per day. However, four elderly patients (over 60 years old) experienced mood swings even with a lower dose of 100 mg per day. 

The study suggests that the age-related decrease in elimination rate and higher concentrations of trazodone in elderly patients might explain why they experienced this side effect with a lower dose.

Additionally, in two cases where patients were simultaneously taking other antidepressants, transitions to manic or depressive moods were triggered by a very low dose of 50 mg per day.

Finally, only one case reports a patient who experienced a switch to hypomania due to the withdrawal of trazodone rather than its administration.

What factors influence trazodone-induced mood swings?

Several factors may contribute to these trazodone-induced mood swings. They include:

• Some individuals who are more sensitive to medications and their side effects are more susceptible to trazodone-related mood swings.

• Taking very high doses of trazodone increases the risk of mood swings.

• Suddenly jumping to a higher dose without applying proper dose escalation under the supervision of a doctor may lead to increased side effects like mood swings.

• Abrupt discontinuation of trazodone can increase the risk of suffering from mood swings as a trazodone withdrawal symptom.

• The concurrent administration of other drugs that may cause mood swings increases the likelihood of experiencing trazodone-related mood swings. These drugs include other antidepressants like Prozac, sertraline, Effexor, oral contraceptives, corticosteroids, sulphonamides, and levodopa [5].

• Individuals with bipolar disorder or borderline personality disorder are more likely to suffer from mood swings while taking trazodone.

• Psychological distress and increased stress levels, possibly due to life events, can also contribute to mood swings while taking trazodone.

• Non-adherence to trazodone, skipping doses, and inconsistent administration of the drug increase the risk of trazodone-induced mood swings. 

What to do if trazodone causes mood swings?

If you are experiencing mood swings as a result of taking trazodone, your first step should be to consult with your doctor. They will assess your condition and adjust your medication dosage accordingly. 

Treatment plan adjustment

To illustrate, your doctor may try gradually reducing the dose and monitor your response to see if it helps manage your mood swings. In certain cases, your doctor might prescribe additional medication specifically for managing the mood swings induced by trazodone.

Research suggests that several medications can potentially help manage trazodone-induced mood swings, including lithium, thiothixene, haloperidol, chlorpromazine, and valproic acid [4]. 

It is also important for you to monitor your symptoms, as well as the frequency, duration, and intensity of your mood swings. This information can be helpful for your doctor to evaluate and monitor your condition. 

Optimize mental health and general wellbeing

Engaging in therapy, such as cognitive-behavioral therapy (CBT), can also be beneficial in managing trazodone-induced mood swings. Additionally, it is important to minimize physical and emotional stress to reduce these mood swings.

Ensuring healthy well-being can be achieved by regularly exercising, maintaining a healthy diet, getting enough quality sleep, and practicing stress-reduction techniques like meditation, yoga, and deep breathing exercises. 

Trazodone discontinuation and switching to alternative drugs.

Finally, if all these strategies don’t help, your doctor may consider discontinuing trazodone gradually to avoid potential withdrawal symptoms. It is crucial to follow their guidance in terms of reducing your dose gradually over time before discontinuation.

Alternatively, your doctor may prescribe a different antidepressant that may not cause mood swings. Other antidepressants that are less likely to cause mood switches include Celexa, Wellbutrin, and Cymbalta.

Based on my research, I found that trazodone may cause mood swings in certain individuals, although it is not a common side effect. The use of trazodone is not recommended for individuals with bipolar disorder, and screening for personal and family histories of the disorder is advised by the FDA. 

From my perspective, factors such as medication sensitivity, high doses, abrupt discontinuation, and concurrent use of other drugs can influence trazodone-induced mood swings.

To manage these mood swings, I recommend consulting with your doctor, who may adjust your treatment plan or prescribe additional medications. 

I also believe that monitoring your symptoms and practicing stress reduction techniques, along with engaging in therapy such as cognitive-behavioral therapy, can be helpful. If needed, your doctor may gradually discontinue trazodone under their guidance. 

Furthermore, I concluded that proper monitoring, communication, and a comprehensive approach can effectively address trazodone-induced mood swings.

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