The antidepressant trazodone is commonly prescribed to treat insomnia. An article by Consumer Reports looks into the safety of this practice.
A handful of studies have shown that trazodone may improve sleep during the first two weeks of treatment. But the drug hasn’t been well-studied for longer than six weeks for people whose primary problem is insomnia. As a result, little is known about how well it works or how safe it is past that point for the treatment of chronic insomnia. Also, an effective dose range has never been established for the drug when it’s being used to treat insomnia, although lower doses are typically given.
Updated treatment guidelines from the American Academy of Sleep Medicine published in 2018 don’t recommend trazodone for chronic insomnia because there’s so little data to support its use. In addition, a May 2018 Cochrane review found that there’s no evidence to support the use of any antidepressant to treat insomnia, including trazodone.
Still, prescribing data suggest that some doctors remain convinced that trazodone is an appropriate sleep medication for many people, even those without depression. Though trazodone is rarely used to treat depression alone anymore, it’s widely prescribed off-label at lower doses for treating insomnia.
One reason could be because that unlike other insomnia drugs, including Ambien, trazodone isn’t classified by the FDA as a controlled substance (PDF) because there’s little risk of it causing dependency and abuse. As a result, doctors can prescribe trazodone without a limit on how many pills a patient can receive. And perhaps because trazodone is unlikely to cause dependence, the high levels of prescribing suggests that many physicians may believe trazodone is safer than other frequently prescribed sleep medications. But there are no studies that confirm this.