Desyrel (Trazodone) is an antidepressant that is prescribed more often for sleep than for depression. Common side effects include drowsiness, dizziness, and dry mouth. Some side effects are specific to women, including menstrual changes, unexpected breast symptoms, and rare prolonged genital arousal. Knowing which effects are common, which are rare, and which need urgent attention can make starting trazodone a lot less unsettling.
Key Takeaways
Drowsiness is by far the most common side effect: In FDA-reviewed outpatient trials, 41% of people taking trazodone reported drowsiness, compared with 20% on placebo. Dizziness followed a similar pattern: 28% versus 15%.
A few effects are specific to female anatomy and hormones: The prescribing information lists early or missed periods among less common reactions (<2%). Postmarketing reports have included breast enlargement or engorgement, lactation (milk production), and clitorism, although the frequency and causal relationship to trazodone are not known.
Low blood sodium deserves attention: Trazodone carries a hyponatremia warning. Research on related antidepressants called selective serotonin reuptake inhibitors (SSRIs) suggests that older age and female sex may increase the risk.
What is Trazodone and How is it Used?
Trazodone is a serotonin antagonist and reuptake inhibitor (SARI). It affects serotonin in the brain by blocking certain serotonin receptors and changing how much serotonin remains available between nerve cells. Trazodone also affects other receptors, which can contribute to some of its effects. Its antihistamine activity can make you feel sleepy, while its effects on alpha-1 receptors can lower blood pressure and sometimes cause lightheadedness, especially when you stand up.
It has been FDA-approved for major depressive disorder in adults since 1981. Although it is not FDA-approved for insomnia, trazodone is sometimes prescribed off-label for sleep. A systematic review and meta-analysis suggests there is adequate data supporting the efficacy and general safety of low-dose trazodone for insomnia. That's why prescribers often consider it. However, trazodone works better for sleep maintenance than for sleep onset.
Dose matters a great deal for side effects. For sleep, trazodone is typically used at doses of 25 to 100 mg, although these doses are off-label. For depression, the labeled starting dose is higher at 150 mg per day, taken in divided doses. Someone taking 50 mg at bedtime may have a different experience than someone taking 300 mg for depression.
How Common Are Trazodone Side Effects?
The FDA prescribing information reported the most common side effects caused by trazodone, which are as follows:
Drowsiness
Dry mouth
Dizziness or lightheadedness
Headache
Blurred vision
Nausea or vomiting
Weight loss
Weight gain
A few things worth keeping in mind. These side effects were reported in studies using trazodone for depression, which typically involves higher doses than what's prescribed for sleep. So, if you’re prescribed a low dose of trazodone for sleep, your actual experience may be milder.
Many side effects tend to appear in the first few weeks and often improve as your body adjusts.
The FDA data isn't broken down by sex, so these findings reflect a clinical population, not women in particular.
Common Trazodone Side Effects in Women
The side effects below are the ones women most commonly report in the first weeks of treatment. They are not exclusive to women, but they are the ones that tend to interfere most with daily life.
Drowsiness and Next-Day Grogginess
Sedation is one of the most common side effects of trazodone, and it is the reason it is prescribed off-label for sleep. The problem is that the sedation does not always stop when morning arrives.
Peak blood levels occur around one hour after a dose on an empty stomach and about two hours after a dose taken with food. Some people may still feel drowsy the next morning. Timing the dose earlier in the evening, or discussing a lower dose, with a prescriber may be an option.
Dizziness and Blood Pressure Drops
Because trazodone blocks alpha-1 adrenergic receptors, it can cause orthostatic hypotension, meaning blood pressure drops when you stand up. This shows up as a head rush, unsteadiness, or, in some cases, fainting.
Falls are a genuine risk, particularly for older women and anyone who gets up during the night. Standing slowly and sitting on the edge of the bed for a moment before standing up can help. So can keeping the path to the bathroom clear and lit — especially in the first weeks.
Dry Mouth and Blurred Vision
Dry mouth and blurred vision are common with trazodone. In clinical studies, dry mouth affected about one-third of outpatients and blurred vision about 15%. But sudden eye pain, redness, or vision changes are different; they need prompt evaluation. In rare cases, antidepressants may cause a sudden rise in eye pressure that can threaten vision.
Weight Changes
Weight changes, including both weight gain and weight loss, have been reported with trazodone, and increased appetite was less common. Clinical trials reported roughly equal cases of weight gain and weight loss (5% vs 6%, respectively). This means trazodone is relatively weight-neutral compared to certain other antidepressants, although some people may still experience weight changes while taking it.
Headache, Nausea, and Fatigue
These may be more noticeable during the first one or two weeks and may improve over time. Taking trazodone shortly after a meal or light snack may reduce stomach upset, although food can delay the time it takes to reach peak blood levels.
Trazodone Side Effects Specific to Females
Some reported side effects involve female reproductive and breast tissue. Most are uncommon, and their true frequency is not clear. Knowing about these effects can help you recognize them if they occur.
Menstrual Cycle Changes
The FDA label lists both early menses and missed periods among adverse reactions occurring in fewer than 2% of people in clinical studies. In practice, this may look like a period arriving earlier than expected, a skipped cycle, or unpredictable timing after starting or changing a dose.
Cycle changes have many possible causes, including stress, sleep disruption, weight change, and the underlying depression or anxiety being treated. If your cycle shifts after starting trazodone, it is worth mentioning to your healthcare provider.
Sexual Side Effects
Sexual side effects with trazodone are not commonly reported. Increased sex drive has been reported in clinical studies (<2%), which is not the typical pattern for serotonergic medications. Decreased libido has also been reported in some studies.
A rarer but more distinctive reaction is clitorism, which is prolonged, often painful clitoral engorgement that doesn't resolve on its own. It's the female counterpart to priapism, a similar prolonged and painful erection in men. Both warrant immediate medical attention.
Breast Changes and Unexpected Milk Production
Breast enlargement or engorgement and lactation in nonbreastfeeding women (galactorrhea) both appear in the label’s postmarketing reports. These side effects are uncommon and may have other causes, including thyroid problems and elevated prolactin from other medications.
Milk production outside of pregnancy or nursing can point to something unrelated to trazodone. It's a symptom that should be evaluated, not simply attributed to the medication.
Low Blood Sodium: A Risk Worth Understanding
Hyponatremia, meaning low sodium in the blood, has its own section in the trazodone prescribing information. Cases with blood sodium levels below 110 mmol per liter have been reported in the label. Women may have a higher risk of hyponatremia.
A review of hyponatremia associated with SSRIs in older adults identified several risk factors, including female sex, concurrent diuretic use, low body weight, and lower baseline sodium. Although trazodone isn't an SSRI, it works on the same serotonin system, which is thought to explain the shared risk.
The trazodone label separately flags three groups of people with certain conditions as being at greater risk. These include older patients, people taking diuretics, and those who are volume-depleted, meaning low on body fluid.
Hyponatremia can be hard to recognize because its symptoms look like everyday problems: headache, trouble concentrating, memory lapses, weakness, confusion, or feeling unsteady. More severe cases can involve fainting or seizures. If you are an older woman, take a diuretic, or have a low body weight, it is better to consult your prescriber before starting trazodone.
Trazodone During Pregnancy and Breastfeeding
These questions come up often, and there's no simple yes-or-no answer. Decisions here should be made with both your prescriber and obstetric provider. In this way, you can weigh the risks of untreated depression against medication exposure.
Pregnancy
According to the FDA prescribing information, studies spanning several decades have looked at trazodone use in pregnancy. None have identified drug-associated risks of major birth defects, miscarriage, or adverse maternal or fetal outcomes. However, absence of identified risk is not the same as proof of safety.
The label also highlights an important point. A study found that pregnant women with a history of major depression were more likely to relapse after stopping their antidepressants during pregnancy. Stopping is not automatically the safer choice. There is also a National Pregnancy Registry for Antidepressants that monitors outcomes, and healthcare providers are encouraged to enroll patients.
Breastfeeding
Trazodone does transfer into human milk. Limited data from postmarketing reports have not identified an association with adverse effects in breastfed infants. There are no data on how trazodone affects milk production. The general guidance is to weigh the health benefits of breastfeeding alongside the mother's clinical need for the medication. This is a decision that should be individualized, not made from a general rule.
Serious Side Effects That Need Prompt Attention
Most trazodone side effects are uncomfortable rather than dangerous. Some are less common but still important to recognize early.
Serotonin syndrome: Agitation, hallucinations, rapid heartbeat, muscle rigidity, tremor, sweating, fever, and gastrointestinal symptoms. Risk rises when trazodone is combined with other serotonergic drugs. These include triptans, tramadol, lithium, buspirone, and St. John's Wort. MAOIs (monoamine oxidase inhibitors) are contraindicated with trazodone and require a 14-day washout before or after use. Serotonin syndrome can also occur with trazodone alone.
Heart rhythm change: Trazodone prolongs the QT interval, the heart's electrical recovery time between beats. The label notes that torsade de pointes, a dangerous rapid heart rhythm, has been reported at doses of 100 mg per day or less. Fainting, a racing or irregular heartbeat, or chest pain should be evaluated promptly.
Prolonged, painful genital swelling: Clitorism in women and priapism in men both require emergency care rather than waiting.
Symptomatic low sodium: Confusion, marked weakness, unsteadiness, or seizure.
Angle-closure glaucoma: Eye pain, sudden vision changes, or redness and swelling around the eye.
Worsening mood or new suicidal thoughts: Trazodone carries a boxed warning about increased suicidal thoughts and behaviors in pediatric and young adult patients. Any new or worsening symptoms should be reported to a healthcare provider right away.
If you are having thoughts of harming yourself, call or text the 988 Suicide and Crisis Lifeline, or go to your nearest emergency room.
How Long Do Trazodone Side Effects Last?
Many early side effects, particularly nausea, headache, and dizziness, tend to improve over the first one to two weeks as the body adapts. Drowsiness often eases as well. For many people, it can persist, which can be helpful when trazodone is used as a sleep aid.
Effects that appear or worsen after several weeks, rather than improving, are a different signal. Low sodium in particular can develop after treatment has been underway, and it is not necessarily dose-dependent. If something new shows up at week four, do not assume it is unrelated. However, one thing not to do is stop abruptly. The prescribing information recommends reducing the dose gradually rather than stopping suddenly. Stopping serotonergic antidepressants quickly can produce nausea, irritability, dizziness, electric shock sensations, anxiety, and sleep disruption.
What Can Help With Trazodone Side Effects
Several adjustments can make the early weeks more manageable. All of them should be run past your prescriber rather than made on your own.
Take it with food: This is specifically recommended in the prescribing information and might be able to help with nausea.
Adjusting the timing: Moving a bedtime dose slightly earlier may reduce morning grogginess.
Standing up slowly: It is better to give yourself a moment between lying, sitting, and standing, particularly at night.
Limit alcohol: This can help, since trazodone has been found to enhance the effects of alcohol and other sedating substances, increasing drowsiness and fall risk.
Reviewing your full medication list: Trazodone interacts with several medicines, including heart medicines, digoxin and phenytoin, and with blood thinners and NSAIDs (nonsteroidal anti-inflammatory drugs). Include supplements, since St. John’s Wort matters here.
Asking about the dose: For sleep, lower doses are often enough, and reducing the dose sometimes resolves a side effect entirely.
If sleep is the reason you were prescribed trazodone, it can also help to look at what else is driving it. Our article on nighttime anxiety covers a common contributor that medication alone does not resolve.
When to Seek Medical Attention
Contact your prescriber if any of the following apply.
Daytime drowsiness is affecting your ability to drive, work, or care for others
You have fainted, come close to fainting, or fallen
Your menstrual cycle has changed noticeably since starting
You notice breast enlargement, tenderness, or unexpected milk production
You feel confused, unusually weak, or unsteady in a way that is new
Side effects have not improved after several weeks, or are getting worse
Seek emergency care for prolonged painful genital swelling, symptoms of serotonin syndrome. The same goes for a racing or irregular heartbeat with fainting, seizure, or sudden eye pain with vision changes.
How Blossom Health Can Help
Side effects are one of the most common reasons people stop a medication that might otherwise have worked for them. Often a dose change, a timing change, or a switch to a different medication resolves the problem. That requires a prescriber who can actually talk it through with you.
Blossom Health connects you with board-certified psychiatric providers for virtual visits covered by in-network insurance, usually within days. Your first appointment is usually an hour-long video visit covering your history, current medications, and what you are experiencing. From there, your healthcare provider will build a plan with you. If a different kind of care would serve you better, they will say so. Get started with Blossom Health to check your coverage and book a time.
Medical Disclaimer
This article is for educational purposes only and does not constitute medical advice. The information provided should not replace consultation with a qualified healthcare provider. Individual responses to medications can vary significantly, and what applies to one person may not be safe for another.
Always consult with your doctor or pharmacist before making any decisions about medication changes, discontinuation, or interactions with other substances. If you're experiencing concerning symptoms or side effects, please seek professional help from a healthcare provider. In case of a medical emergency, contact your local emergency services immediately or call 911. For mental health emergencies, contact the National Suicide Prevention Lifeline at 988.
Important: This information is not a substitute for professional medical advice. Never stop taking prescribed medication or make changes to your treatment plan without consulting your healthcare provider first. Your safety and well-being are the top priorities.
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