Trazadone 250mg and sleep

[biba]

I posted last year when I was prescribed 200mg trazadone and 75mg venlafaxine and has some difficulties. Things were better.
I stopped the venlafaxine about 6 weeks ago and increased the trazadone to 250mg 12 days ago. This has been very challenging with very early waking and increased anxiety again. Is this likely to improve or might I need to increase the trazadone further?
Thanks for any advice or thoughts.

[Scissel]

Trazadone used to work pretty well for me - only thing in the morning I felt like I was clubbed Lol..

The anxiety should go away after a while. Didi you also have this anxiety on 200mg as well?

Hopefully @panic_down_under will see this as he knows loads more than I do to help you.

[Scissel]

...I stopped the venlafaxine about 6 weeks ago and increased the trazadone to 250mg 12 days ago ...

Did they replace the venlafaxine with something else or is the trazadone taking the place of it?

[panic_down_under]

I stopped the venlafaxine about 6 weeks ago and increased the trazadone to 250mg 12 days ago. This has been very challenging with very early waking and increased anxiety again. Is this likely to improve or might I need to increase the trazadone further?

I suspect the side-effects are from quitting venlafaxine, not trazodone. It is considered the most difficult AD to quit although those who've quit paroxetine (Paxil) will disagree. How did you taper off it?

[biba]

Thanks, both for your replies. I thought I'd approached coming off venlafaxine sensibly. I reduced to 37.5mg daily for 3 months and then stopped. I thought that the trazadone was a viable alternative. Might things level out soon? The early morning waking is a killer and I end up taking zopiclone and or diazepam to get back to sleep.
Thanks again to you both 😊

[panic_down_under]

Thanks, both for your replies. I thought I'd approached coming off venlafaxine sensibly. I reduced to 37.5mg daily for 3 months and then stopped.

Unfortunately, quitting from 37.5mg is usually way too big of a drop. Halving it for 2-3 weeks then halving it again for another 2-3 weeks may have been better, but venlafaxine can be so difficult to quit for some that they need to hyperbolic taper off. See: Examples of tapering plans.

If you were switching to a longish half-life SSRI such as citalopram, escitalopram or fluoxetine it would be less of an issue as they have the same affect on serotonin reuptake as venlafaxine, but trazodone isn't a SSRI so can't take over their role.

I thought that the trazadone was a viable alternative.

It can be a very effective antidepressant and often produces few side-effects than SSRIs, SNRIs and TCAs. The reason it is not often prescribed is it is very sedating at low doses. It should be more popular now that extended-release tablets are available as they are better at keeping plasma levels above the sedation threshold, but old beliefs are hard to overcome. It is actually the second most prescribed antidepressant in the U.S., but that's because it is mostly being prescribed at low doses for SSRI/SNRI induced insomnia.

The early morning waking is a killer and

Are you on immediate, or extended-release tablets? Trazodone has a very short half-life, 5-14 hours so most of the med will soon be metabolized if you're on the immediate-release. What time of day do you take it?

I end up taking zopiclone and or diazepam to get back to sleep.

Not a good idea, especially the diazepam. Firstly, you're taking a med with a 200 hour half-life to get a couple of hours sleep. Secondly, benzodiazepines actually worsen the physical cause of anxiety and depression and reduce antidepressant effectiveness. Plus, tolerance to their sedation soon develops. Often within a couple of weeks.

Anxiety disorders and depression are the emotional symptoms of atrophy of parts of the two hippocampal regions of the brain caused by high brain stress hormone levels killing neurons and inhibiting the growth of new ones:

• Depression, antidepressants, and the shrinking hippocampus[/INDENT]

Antidepressants (also CBT, REBT, mindfulness therapies) work by stimulation the growth of new hippocampal cells (neurogenesis). It is the new cells and the connections they form which produce the therapeutic response:

• What is neurogenesis?
  
  
• Structural changes in the hippocampus in major depressive disorder: contributions of disease and treatment
  
  
• Association Among Clinical Response, Hippocampal Volume, and FKBP5 Gene Expression in Individuals with Posttraumatic Stress Disorder Receiving Cognitive Behavioral Therapy

Benzodiazepines block neurogenesis:

• Benzodiazepines And The Potential Trophic Effect Of Antidepressants On Dentate Gyrus Cells In Mood Disorders
  
  
• A benzodiazepine impairs the neurogenic and behavioural effects of fluoxetine in a rodent model of chronic stress
  
  
• Co-Treatment with Diazepam Prevents the Effects of Fluoxetine on the Proliferation and Survival of Hippocampal Dentate Granule Cells
  
  
• See also: the 'Ugly' part of Benzodiazepines: The Good, The Bad, and the Ugly

[biba]

Thanks so much for your responses, Panic Down Under. I appreciate your insights.
I've been using g diazepam and zopiclone on and off for years so I'm interested to hear about interactions with ADs. Sometimes they're the only things that get me sleep.
I take thr immediate release version of trazodone which maybe accounts for 3am waking. Should I ask about the extended release version?
I also wonder about going back on a low dose of venlafaxine.
Might things level out soon, do you think or make an adjustment?
Thanks again for your thoughts. You're a very helpful resource 👍🏻

[biba]

Also, do you know anything about Daridorexant as s treatment for insomnia?

[Scissel]

Also, do you know anything about Daridorexant as s treatment for insomnia?

I've never heard of that one until you mentioned it. I also take Zolpidem for insomnia. Yeah, PDU knows his stuff alright - he's been very helpful to me at times when I needed help.

[Scissel]

Have you had success cutting back on the benzodiazepines? I've tried and its proven to be very very difficult for me. You?