Trazodone (Reslin)
What is trazodone?
Trazodone is sold in Japan as Reslin (レスリン on Japanese packaging) and as generic trazodone; in the UK and the US it's usually prescribed simply as trazodone. It's an older serotonin-acting antidepressant whose character is calming rather than activating.
How is it different from other antidepressants?
- Calming rather than activating: the Japanese label notes a second action, separate from its antidepressant effect, that improves the sleep problems that come with depression
- Not habit-forming: it is an antidepressant, not a sleeping pill, and it carries no dependence warning
- Flexible dosing: the daily amount can be taken in one dose or split into several, so timing can be adjusted
- Only one absolute contraindication: a past allergic reaction to it; the label lists nothing else
What is it used for in Japan?
Depression.
How does it help?
It increases serotonin signalling, which eases low mood over time, and it has a separate calming action that helps the sleep problems that come with depression. The effect on mood builds gradually over weeks. If you don't feel better right away, that's normal; keep taking it as prescribed.
What should I tell my doctor before starting?
Trazodone suits most people, and only one situation rules it out entirely:
- A past allergic reaction to trazodone
And tell your doctor first if any of these apply; these usually just need adjustments or a closer eye:
- Other antidepressants (including MAO inhibitors), tramadol (a painkiller), migraine triptans, or lithium
- Blood pressure medicines: trazodone can add to their effect and cause lightheadedness or fainting
- Heart disease, a recent heart attack, or a heart rhythm problem
- Glaucoma or difficulty passing urine
- A history of seizures
- Bipolar disorder
- Past suicidal thoughts, or strong impulsivity: the label asks for closer monitoring
- Blood thinners, or regular painkillers like ibuprofen
- HIV medicines containing ritonavir (also part of the COVID treatment Paxlovid); the dose may need lowering
- Other sedating medicines, or regular alcohol use
- St John's Wort supplements
- Being older: a lower dose is often used
- Pregnant, planning to be, or breastfeeding (see the section below)
Your doctor may check your heart rhythm with an ECG from time to time, as the Japanese label asks, because trazodone can affect it.
How do I take it, and what if I miss a dose?
Trazodone is taken once to several times a day, as set by your doctor.
- If you miss a dose: take it when you remember, unless the next dose is close; in that case just skip. Never take a double dose to catch up
- Morning heaviness: it can happen in the first days; if it lingers, tell your doctor, since timing and dose can be adjusted
- Alcohol: avoid it as far as possible; the Japanese label asks for this because alcohol strengthens trazodone's sedating effect
What side effects should I expect?
Many are mild and ease as your body adjusts, and many can be eased with a counter-medicine (for nausea, for example). Not everyone gets them.
- Drowsiness
- Feeling lightheaded when standing up: get up slowly, especially at night
- Headache
- Dry mouth
- Constipation
- Nausea
- Tiredness
If anything is bothering you, tell your doctor; there's often a way to adjust. And if you ever feel worse instead of better, tell us straight away; it's easily managed, and that's what we're here for.
Finally, one thing that is rare (most people never experience it) but good to know:
- For men: an erection that persists for hours without stimulation isn't safe to wait out; stop the medicine and get medical care the same day, and it's treatable
Will I become dependent? How do I stop safely?
No; trazodone isn't addictive, but it does need a planned, gradual stop. There's no craving and no urge to take more. Stopping suddenly can bring withdrawal-like symptoms, which the Japanese label lists as nausea, headache, tiredness, anxiety, and poor sleep, so don't stop suddenly on your own; your doctor lowers the dose step by step, and coming off is planned together.
Can I drive while taking it?
The Japanese label advises against driving while taking it. Trazodone can cause drowsiness and slow your reactions, and the prescribing information here instructs that patients on it shouldn't drive or operate dangerous machinery. If morning carry-over keeps happening, tell your doctor; dose and timing can be adjusted.
What about pregnancy and breastfeeding?
Tell your doctor early; this is decided case by case. The Japanese label allows trazodone in pregnancy when the benefit is judged to outweigh the risk, and in breastfeeding it asks for the benefits of treatment and of breastfeeding to be weighed; only a very small amount passes into milk. Don't stop or continue on your own. Our guides to medication in pregnancy and medication while breastfeeding cover the details.