Does Trazodone Help With Anxiety? What You Should Know About Off-Label Use

Quick Answer: Trazodone isn’t FDA-approved for anxiety, but research shows it can help reduce anxiety symptoms when doctors prescribe it “off-label.”

Here’s what the main study found: About 7 out of 10 people with anxiety felt meaningfully better on trazodone, compared to only 5 out of 10 people taking a sugar pill [1].

However, everyone responds differently to medications. This depends on your genetics, other health conditions, and what other medications you take. Trazodone can also cause side effects, including heart rhythm changes and a rare but serious condition affecting men.

Always talk with a healthcare provider to see if trazodone might be right for your situation.

This information is for educational purposes only and should not replace professional medical advice, diagnosis, or treatment. Always consult with qualified healthcare providers regarding any questions about medical conditions or treatments. If you’re experiencing thoughts of self-harm or suicide, please reach out for immediate help by calling or texting 988 for the Suicide & Crisis Lifeline, or visit your nearest emergency room.

If you’re researching whether trazodone might help with your anxiety, you’re probably feeling frustrated. Maybe you’ve tried other medications that didn’t work or caused side effects you couldn’t handle. Perhaps you’re dealing with both anxiety and trouble sleeping, and nothing seems to help both problems.

You’re not alone in this search. Many people find themselves looking into different options when the first treatments they try don’t provide enough relief.

Why People Look Into Trazodone for Anxiety

When your anxiety hasn’t gotten better with common treatments, it makes sense to research other options. Trazodone often comes up for reasons that many people can relate to.

You’ve tried SSRIs with problems

Maybe you tried medications like Zoloft or Lexapro, but they caused issues you couldn’t live with. These might include:

• Sexual problems (which affect about 7 or 8 out of 10 people taking these medications) [2]
• Sleep problems that made your anxiety worse
• Feeling “wired” or more anxious when you first started taking them

This experience is incredibly common and frustrating. Your feelings about wanting something different are completely valid.

Anxiety keeps you awake at night

If you’re lying in bed with racing thoughts, you might need something that helps both anxiety and sleep. Trazodone works differently than many other anxiety medications. It can calm your mind and help you sleep at the same time.

Most other anxiety medications either help anxiety but keep you awake, or help you sleep but don’t do much for daytime anxiety.

You’re worried about addiction

You might have heard about medications like Xanax but feel concerned about becoming dependent on them. This is a smart concern, especially if you need long-term help with anxiety.

Trazodone works completely differently. It doesn’t create the same addiction risks as medications like Xanax or Ativan [4].

Understanding where trazodone fits

It’s important to know that doctors don’t usually try trazodone first for anxiety. Current medical guidelines recommend SSRIs or SNRIs as the first-line treatment for most anxiety disorders. They typically consider trazodone when:

• Other medications haven’t worked well enough
• You’ve had side effects you couldn’t handle
• You have both anxiety and sleep problems
• You have specific reasons to avoid other types of anxiety medications

When doctors prescribe trazodone for anxiety, they’re using their medical judgment that it might help your specific situation. This is called “off-label” use, and it’s completely legal and often appropriate.

What Research Shows About Trazodone for Anxiety

The strongest evidence comes from a well-designed 1993 study [1] that compared trazodone to Valium (diazepam) and placebo in people with generalized anxiety disorder (GAD).

The main study results
 The study included 230 participants over 8 weeks:

• Trazodone group: About 69% experienced moderate-to-marked improvement
  
  
• Valium group: About 66% experienced moderate-to-marked improvement
  
  
• Placebo group: About 47% experienced improvement

This showed that trazodone was nearly as effective as Valium for reducing anxiety.

How the improvements happened

• First 2 weeks: Valium worked faster on physical anxiety symptoms, such as muscle tension and somatic discomfort.
  
  
• Weeks 3-8: Trazodone caught up, showing comparable efficacy, particularly for psychiatric symptoms like worry, apprehension, and feeling on edge.

Other supporting research

Smaller studies have found that trazodone can help with:

• Panic attacks and fear of going places (though this was a small study) [5]
• Anxiety and nightmares related to trauma [6]
• Sleep problems that come with anxiety [3]

What this means for you

These results are encouraging, but remember that about 3 out of 10 people in the study didn’t get significant relief from trazodone. Whether it helps you depends on many things, including:

• Your specific type of anxiety
• Other health conditions you have
• Biochemical individuality and variation
• Medications you’re already taking
• How your body processes medications (which varies from person to person)

How Trazodone Works in the Brain

Although originally developed as an antidepressant, trazodone is often prescribed off-label for anxiety and insomnia. Its benefits stem from its multimodal pharmacology—it influences several neurotransmitter systems simultaneously, which helps explain its versatility.

Mechanisms Relevant to Anxiety

• Enhancing serotonin activity: Trazodone acts as a serotonin reuptake inhibitor, modestly increasing serotonin availability in the brain. More balanced serotonin activity is associated with reduced anxiety and improved mood.
• Blocking overactive receptors: Trazodone antagonizes 5-HT2A receptors, which are linked to agitation, anxiety, and disrupted sleep. Blocking these receptors produces calming and anxiolytic effects.
• Reducing hyperarousal: By also blocking certain adrenergic receptors, trazodone dampens excessive sympathetic nervous system activity (e.g., elevated heart rate, blood pressure), supporting a more relaxed physiological state.

Why It Also Improves Sleep

The same receptor actions that reduce anxiety—particularly 5-HT2A antagonism and antihistamine effects—also promote sedation. This makes trazodone a frequently chosen option for patients with co-occurring anxiety and insomnia.

Dosing Considerations

Trazodone’s effects differ by dose:

• For anxiety or insomnia: often effective at 50–150 mg per day
• For depression: typically requires 150–300 mg perdayThis dosing distinction allows clinicians to target anxiety and sleep without reaching higher antidepressant doses that may cause more side effects.

Timeline of Effects

• Immediate (within 1–3 hours): sedation or calming effects are common, though these do not reflect the full therapeutic impact.
• 1–2 weeks: some patients begin noticing meaningful reductions in anxiety.
• 4–6 weeks: maximal benefits are typically observed, consistent with other serotonergic medications.

Responses vary by individual, and clinicians usually recommend consistent use and monitoring before adjusting the dose or determining effectiveness.

How Trazodone Compares to Other Anxiety Medications

Understanding how trazodone differs from other commonly prescribed medications for anxiety can help clarify when it might be an appropriate option.

Trazodone vs. SSRIs (e.g., sertraline/Zoloft, escitalopram/Lexapro, fluoxetine/Prozac)

Selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatments for anxiety disorders in current clinical guidelines. Compared with SSRIs, trazodone offers distinct advantages and trade-offs:

• Sleep: SSRIs frequently exacerbate insomnia when first initiated [3], whereas trazodone almost always improves sleep due to its sedating properties.
• Sexual side effects: SSRIs are associated with high rates of sexual dysfunction, varying by medication and dose [2]. Trazodone rarely causes these problems and may even counteract SSRI-induced sexual dysfunction.
• Initial effects: Some patients experience increased jitteriness or heightened anxiety when starting SSRIs, a phenomenon less common with trazodone, which typically exerts a calming effect from the outset.
• Trade-offs: Trazodone is more likely to cause daytime drowsiness and orthostatic hypotension (blood pressure drops when standing), which can limit tolerability in some patients.

Trazodone vs. Benzodiazepines (e.g., alprazolam/Xanax, lorazepam/Ativan, clonazepam/Klonopin)

Benzodiazepines are highly effective for acute anxiety relief, but their use is limited by safety concerns with long-term use. Compared with benzodiazepines, trazodone differs in several key ways:

• Addiction risk: Benzodiazepines carry a risk of dependence, tolerance, and withdrawal [4]. Trazodone does not share these addictive properties.
• Onset of action: Benzodiazepines act rapidly, often within an hour, while trazodone typically requires 1–2 weeks for noticeable benefit and 4–6 weeks for full effect.
• Duration of safe use: Benzodiazepines are best reserved for short-term or intermittent use, whereas trazodone can be prescribed safely for months or years, provided patients are monitored.
• When each is appropriate: Benzodiazepines may be more suitable for immediate relief of panic attacks, while trazodone is often a better fit for long-term anxiety management, particularly in patients with co-occurring insomnia.

Trazodone vs. Buspirone

Buspirone is another non-addictive anxiety medication:

Energy levels: Buspirone doesn’t make you sleepy and might even give you a bit more energy. Trazodone has a calming, sleepy effect.

When to choose which: If you mainly have worry without sleep problems, buspirone might be better. If sleep issues are a big part of your anxiety, trazodone could be more helpful.

Making the choice

The best medication for you depends on:

• Whether sleep is a major problem
• How you’ve responded to other medications
• Your daily schedule and lifestyle
• Other health conditions you have

Side Effects You Should Know About

Like all medications, trazodone can cause side effects. Most are manageable, but some require immediate medical attention.

Common side effects

These affect many people but are usually mild:

Feeling drowsy or sleepy: This happens to about 4 out of 10 people [4]. It’s often strongest 1-3 hours after taking the medication and may last into the next day when you’re starting treatment.

Dizziness when standing up: About 3 out of 10 people notice this [4]. It happens because trazodone can lower your blood pressure. Standing up slowly usually helps.

Dry mouth: About 3 out of 10 people experience this [4]. Sugar-free gum, frequent sips of water, or saliva substitutes can help.

Nausea or stomach upset: This affects about 1 out of 10 people, but taking trazodone with food usually prevents it [4].

Headaches: About 2 out of 10 people get headaches, especially in the first few weeks [4]. These often improve as your body adjusts.

Most people find these side effects either go away after a few weeks or become manageable with simple strategies.

Serious side effects requiring immediate medical attention

While uncommon, some side effects need emergency care:

For men – Priapism: This is a painful erection lasting more than 4 hours. It affects about 1 in 6,000 men taking trazodone [4]. If this happens, go to the emergency room immediately to prevent permanent damage.

Heart rhythm problems: Trazodone can affect how your heart beats [4]. Call your doctor right away if you have chest pain, feel like your heart is racing or skipping beats, or feel faint.

Serotonin syndrome: This can happen if trazodone is combined with certain other medications [4]. Signs include high fever, muscle stiffness, confusion, and rapid heartbeat. This is a medical emergency.

Severe allergic reactions: Though rare, some people develop serious allergic reactions including trouble breathing or severe skin reactions.

Who needs extra caution

Older adults: May be more sensitive to blood pressure changes and drowsiness, which can increase fall risk.

People with heart problems: Need closer monitoring because trazodone can affect heart rhythm and blood pressure.

If you take other medications: Trazodone can interact with many other drugs, so your doctor needs to know everything you’re taking.

Managing side effects

Most side effects can be managed by:

• Starting with a low dose and increasing slowly
• Taking the medication with food
• Taking it at bedtime to reduce daytime drowsiness
• Standing up slowly to prevent dizziness
• Staying well-hydrated and nourished
• Getting sufficient sleep, sunshine and nature exposure.

Always talk to your doctor before stopping or changing your dose, even if you’re having side effects.

Talking to Your Doctor About Trazodone

If you’re interested in trying trazodone for anxiety, preparing for the conversation can help you get the most out of your appointment.

Before your appointment

Write down your anxiety symptoms: Include when they happen, how intense they are (maybe on a 1-10 scale), and how they affect your daily life. Also note any sleep problems.

List what you’ve tried before: Include medications, doses, how long you took them, and why you stopped. Be honest about both good and bad effects.

Gather your current medications: Make a complete list including vitamins, supplements, and over-the-counter medications.

Think about your goals: What would “better” look like for you? Better sleep? Less worry during the day? Being able to do activities you’ve been avoiding?

Questions to ask

“Would trazodone be worth considering for my type of anxiety?” This helps you understand if it fits your specific situation.

“How long before I’d know if it’s working?” This sets realistic expectations for timing.

“What side effects should I watch for, and when should I call you?” This helps you feel prepared and safe.

“How would this fit with my other treatments?” If you’re in therapy or taking other medications, you want to know how everything works together.

“What would starting and stopping look like?” Understanding the process can reduce anxiety about trying something new.

What your doctor will want to know

Your doctor will likely ask about:

• Your specific anxiety symptoms and how long you’ve had them
• How anxiety affects your sleep and daily activities
• Your medical history, especially any heart problems
• What other treatments you’ve tried and how they worked
• Your concerns about different types of medications

Understanding “off-label” use

Your doctor may explain that using trazodone for anxiety is “off-label.” This means:

• The FDA hasn’t specifically approved it for anxiety
• There’s good research showing it can help
• It’s completely legal and often appropriate
• Your doctor is using their medical knowledge to help you

This is actually very common in medicine and doesn’t mean you’re getting experimental treatment.

Setting up a plan

If you and your doctor decide to try trazodone, you’ll likely discuss:

• What dose to start with (usually low)
• How often you’ll check in
• What to watch for
• How long to try it before deciding if it’s working

Remember, this is a collaboration. Your doctor brings medical expertise, but you’re the expert on your own experience with anxiety.

When You Need Help Right Away

While this information can help you understand trazodone as a treatment option, some situations need immediate professional attention.

Get emergency help immediately if you have:

Thoughts of hurting yourself: Call or text 988 for the Suicide & Crisis Lifeline, call 911, or go to your nearest emergency room. Don’t wait – these feelings can be treated, and help is available right now.

Signs of serotonin syndrome: High fever, muscle stiffness, confusion, rapid heartbeat, or feeling very agitated. This can be life-threatening and needs emergency treatment.

Heart problems: Chest pain, severe heart palpitations, fainting, or trouble breathing could mean serious heart rhythm problems.

Priapism (for men): Any erection lasting longer than 4 hours is a medical emergency that can cause permanent damage if not treated immediately.

Severe allergic reactions: Trouble breathing, swelling of your face or throat, or severe skin reactions need emergency care.

Schedule an appointment soon if:

Your current anxiety treatment isn’t working: If you’ve been on the same anxiety medication for several months without enough improvement, it’s time to explore other options.

Side effects are making your life difficult: Medications should make you feel better, not create new problems that are just as disruptive.

Anxiety and sleep problems are both major issues: When you’re dealing with both, you often need specialized treatment approaches.

You’re using alcohol or other substances to manage anxiety: This can be dangerous and usually means you need professional help.

Your anxiety is getting worse: Any significant increase in anxiety symptoms should be evaluated promptly.

Consider scheduling a consultation if:

• You’re curious whether trazodone might help your anxiety
• You’ve had mixed results with other anxiety medications
• You want to work with a provider who specializes in anxiety treatment
• You’d like to explore medication options while continuing therapy

Remember, asking for help with anxiety shows strength, not weakness. Anxiety is a real medical condition that responds well to proper treatment. Finding the right approach often takes professional guidance, and that’s completely normal.

What You Should Remember

Here are the key points about trazodone for anxiety:

Research supports its use: Studies show trazodone can be as effective as proven anxiety medications like Valium. About 7 out of 10 people with anxiety feel meaningfully better on trazodone.

Everyone responds differently: While most people in studies improved, about 3 out of 10 didn’t see major benefits. Your response depends on your genetics, health conditions, and other factors unique to you.

It has unique advantages: Trazodone may be especially helpful if you struggle with both anxiety and sleep problems, have had sexual side effects from other medications, or want to avoid addiction risks.

Safety monitoring matters: While generally safe, trazodone can cause serious side effects including heart rhythm changes and a rare condition affecting men. Regular check-ins with your doctor are important.

It’s usually a second choice: Doctors typically consider trazodone when first-line treatments haven’t worked well enough or caused problems you couldn’t handle.

You need professional guidance: Because this is off-label use with important safety considerations, trazodone for anxiety should only be used under medical supervision.

Patience is important: It can take 4-6 weeks to know if trazodone is really helping your anxiety, so don’t expect immediate results.

If you’re struggling with anxiety that hasn’t improved with standard first-line treatments like SSRIs or SNRIs, trazodone might be worth discussing with a healthcare provider. The key is finding someone who understands both the research behind its use and the careful monitoring it requires.

Effective anxiety treatment is possible, even when the first approaches you try don’t work perfectly. Working with experienced providers who know about all your options – including thoughtful off-label uses like trazodone – can help you find the relief you’re looking for.

How PsychPlus Can Help You Find the Right Treatment

At PsychPlus, we understand that finding effective anxiety treatment often feels overwhelming, especially when you’ve tried other approaches without finding the relief you need. Our board-certified psychiatric providers specialize in complex anxiety treatment and can help you explore whether trazodone or other evidence-based options might be appropriate for your specific situation. Ready to work with a provider who understands the challenges of anxiety treatment? Schedule a consultation with a PsychPlus provider to discuss your options and develop a personalized treatment plan.

Sources

[1] Rickels, K., Downing, R., Schweizer, E., & Hassman, H. (1993). Antidepressants for the treatment of generalized anxiety disorder. Archives of General Psychiatry, 50(11), 884-895. https://doi.org/10.1001/archpsyc.1993.01820230054005

[2] Serretti, A., & Chiesa, A. (2009). Treatment-emergent sexual dysfunction related to antidepressants: A meta-analysis. Journal of Clinical Psychopharmacology, 29(3), 259-266. https://doi.org/10.1097/JCP.0b013e3181a5233f

[3] Shin, J. J., & Saadabadi, A. (2024). Trazodone. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470560/

[4] DESYREL® (trazodone hydrochloride) prescribing information. (2017). U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018207s032lbl.pdf

[5] Mavissakalian, M., Perel, J., Bowler, K., & Dealy, R. (1987). Trazodone in the treatment of panic disorder and agoraphobia. American Journal of Psychiatry, 144(6), 785-787. https://pubmed.ncbi.nlm.nih.gov/3296792/

[6] Warner, M. D., Dorn, M. R., & Peabody, C. A. (2001). Survey on the usefulness of trazodone in patients with PTSD. Pharmacopsychiatry, 34(4), 128-131. https://doi.org/10.1055/s-2001-15871

[7] Stahl, S. M. (2009). Mechanism of action of trazodone: A multifunctional drug. CNS Spectrums, 14(10), 536-546. https://pubmed.ncbi.nlm.nih.gov/20095366/

[8] NHS. (2024). How and when to take trazodone. National Health Service. https://www.nhs.uk/medicines/trazodone/how-and-when-to-take-trazodone/

[9] Mayo Clinic. (2024). Trazodone (Oral Route). Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/drugs-supplements/trazodone-oral-route/description/drg-20061280

[10] Drugs.com. (2024). Trazodone Uses, Dosage, Side Effects & Warnings. https://www.drugs.com/trazodone.html