Does trazodone treat PTSD? (+3 studies)

In this article, we will discuss whether trazodone treats PTSD. We will also discuss the uses of trazodone in PTSD, and share the evidence of its efficacy in treating PTSD and other relevant information. 

Does trazodone treat PTSD? 

Trazodone treats post-traumatic stress disorder (PTSD) but is not the first-line treatment. It is used off-label to treat insomnia and nightmares associated with PTSD. Trazodone can be used in PTSD as a second-line treatment. 

Trazodone is a serotonin antagonist and reuptake inhibitor (SARI) and is FDA-approved to manage major depressive disorder (MDD). Off-label, it has been used to manage insomnia and nightmares in PTSD due to its sedative properties(1).

Trazodone is the second-line treatment of PTSD (1). The first-line treatment of PTSD includes antidepressants from the class of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (2).

Thus, trazodone is considered when the first-line treatment of PTSD has failed. It can also be used along with SSRIs to manage insomnia and nightmares in PTSD (2).  

What are the symptoms of PTSD?

PTSD occurs as a result of an individual experiencing or witnessing a traumatic event. Following the event, specific symptoms appear that impair the daily functioning of the individual. The symptoms of PTSD include (2):

• flashbacks of the traumatic event
• nightmares
• negative changes in mood and cognition
• intrusive thoughts
• difficulty sleeping
• hypervigilance
• emotional reactivity 

The diagnosis of PTSD is made by the healthcare provider based on specific criteria. If you experience the symptoms of PTSD, you must contact your healthcare provider. 

How does trazodone treat PTSD?

Trazodone affects several neurotransmitters to produce its therapeutic response. It inhibits serotonin reuptake and elevates the levels of this neurotransmitter (1). Altered serotonin levels are involved in the development of PTSD (2). 

Trazodone also functions as an inhibitor of some serotonin, histamine (H2), and alpha-1 adrenergic receptors. This antagonist effect contributes to its sedative effects (1). 

Trazodone also reduces the levels of some neurotransmitters that are involved in arousal like serotonin, dopamine, and norepinephrine. Thus, trazodone improves the quality of sleep of an individual (1). 

As trazodone improves sleep, it treats insomnia which commonly occurs in PTSD. Trazodone’s impact on sleep continuity and rapid eye movement (REM) sleep reduces the occurrence of nightmares which is a common symptom of PTSD.

What does research suggest?

Several studies have explored the efficacy of trazodone in managing PTSD symptoms. A review of the medications used to treat nightmares in PTSD suggests that different doses of trazodone have been effective in managing this symptom (3).

In a survey conducted at a healthcare facility, 60 patients received treatment with trazodone for nightmares and sleep disturbances. 72% of these patients reported that their nightmares were reduced and sleep improved after taking trazodone (4). 

In another trial of trazodone, different doses were tested until the optimum effect was obtained in managing PTSD. The results demonstrated that trazodone reduced PTSD scores and sleep was the first symptom resolved by trazodone (5). 

What is the effective dose of trazodone for PTSD?

Several doses of trazodone have been investigated for treating PTSD. Trazodone can be used solely for sedation when combined with other antidepressants to manage PTSD. At doses of 25-100mg, trazodone only has a sedative effect. 

Trazodone has antidepressant activities at the doses of 150-600mg. A review of medications used to manage nightmares in PTSD mentions several studies where trazodone was used in different doses (3). 

The review mentions that trazodone has shown effectiveness in managing PTSD at the dose range of 50 to 400mg. Thus, the dosing range for trazodone in addressing sleep issues in PTSD is wide. 

How does trazodone compare to other PTSD medications?

The first-line treatment of PTSD includes SSRIs and SNRIs. Paroxetine and sertraline have been approved by the FDA to treat PTSD (1). Studies have shown that different SSRIs are effective in managing PTSD and reducing the risk of relapse (6).

Some evidence mentions that SSRIs may not be as effective for PTSD and targeting the frequent symptoms of PTSD like insomnia and nightmares with drugs like trazodone can be a more promising approach (7). 

This evidence discusses that addressing the frequent symptoms can also improve the other symptoms of PTSD and trazodone can be used initially in this approach (7). 

However, the official data on trazodone reports that using trazodone in patients with PTSD who also experienced panic symptoms resulted in worsening of the symptoms in some cases (1). 

Thus, trazodone is not the first-line treatment of PTSD and SSRIs are safe and well tolerated in treating PTSD. Non-SSRIs like trazodone should only be used if SSRIs have not been effective in managing PTSD (1,7). 

Additionally, trazodone can also be combined with SSRIs to address sleep disturbances in PTSD. The suitable treatment and combination of drugs is based on individual symptoms and is decided by the healthcare provider. 

What are the other treatment options for PTSD?

Psychotherapy and pharmacotherapy, both are utilized in the treatment of PTSD. The treatment options are as follows. 

Psychotherapy:

It is considered the first line of treatment for PTSD. Different psychotherapeutic approaches have been found effective for PTSD such as (2):

• cognitive behavioral therapy (CBT)
• eye movement desensitization and reprocessing (EMDR)
• cognitive processing therapy
• imaginal exposure therapy

Trauma-focused psychotherapy is utilized in PTSD and is effective. Combined treatment with psychotherapy and pharmacotherapy has been effective for PTSD. Psychotherapy alone has also shown efficacy in improving PTSD symptoms. 

Pharmacotherapy:

The first line of treatment for PTSD includes (2):

• SSRIs like paroxetine and sertraline
• SNRIs like venlafaxine

Some other drugs can be added to the first-line treatment of PTSD to manage different symptoms like nightmares and insomnia. These drugs include (2):

• clonidine
• prazosin
• trazodone
• risperidone 

In my perspective, trazodone treats PTSD but is not the first-line treatment of PTSD. It is combined with the first-line treatments of PTSD like SSRIs and SNRIs to manage nightmares and insomnia associated with PTSD. 

If SSRIs and SNRIs have failed to treat PTSD, trazodone can be used as a second-line treatment. Research suggests that different doses of trazodone have shown efficacy in improving sleep and reducing nightmares in PTSD patients. 

Psychotherapy is also in the first-line management of PTSD. It can be combined with medications to improve the outcomes. Evidence shows that trazodone can be used along with SSRIs and SNRIs or be considered a second-line treatment for PTSD. 

References