Amanda
Guys, I have a lot of experience with Trazodone and Trazodone withdrawal, and I just wanted to share my experience with you and offer some advice.
1) Non habit-forming my ass. You are all absolutely right. I have been diagnosed with major depressive disorder as well as ADHD. I have a family history of substance abuse, and while I appear to be a high function, high achieving, healthy young adult to most people, I have been struggling with my own internal demons for quite awhile. I have experienced withdrawal from just about every type of prescription medication (SSRIs, amphetamines, benzos, opiates), and trazodone is BY FAR the worst thing I have EVER experienced in my life. No, it's not just you. It's absolutely goddamn horrible.
2) Amount of time taking it makes a huge difference, more of a difference than the size of the dose. The first time I took trazodone, I was taking upwards of 250mg A NIGHT, and redosing halfway through the night, because my insomnia was so bad; however, I only took it for a few months, and while discontinuing quickly still really sucked, I don't recall having much of a problem with a relatively aggressive taper over about a month or two. The SECOND time I started taking Trazodone, I only ever took about 75mg MAX, but have been on it for over a year. I've tapered down to something like 40mg, and just that much has been an absolute nightmare from hell. I have experienced depression, anxiety, thoughts of bodily harm (never in my life have I contemplated cutting myself until this), suicidal ideation (also never in my life contemplated suicide), diarrhea, muscle aches, fatigue, brain fog, itching, hemorrhoids, reduced libido, hair loss, and probably even more that I'm forgetting about.
3) DO NOT STOP COLD TURKEY. DO NOT EVEN ATTEMPT A RAPID TAPER. Don't get me wrong, I'm the type of guy who ALWAYS goes for the rapid detox, because I think I can handle it, and I always could. Trazodone is a different beast, though. It's just not worth it. Unlike detoxing from most other medications, symptoms linger for what I feel like is closer to a month just from reducing by 1/5 the dose. It can completely take your life away from you during this time, destroy relationships, cost you your job, cost you mental stability... Even if the physical symptoms have gone away, those can possibly linger. My brother basically stopped a high dose cold turkey and wound up in a mental ward for a few weeks and now has lingering tinnitus and slight visual issues that he swears is from trazodone. You have to give your receptors a chance to heal before you rip the carpet out from under them. Serotonin is responsible for far more than just your mood. You're screwing with your entire nervous system here, so take your goddamn time and taper at the rate that your receptors can keep up. If it takes a year, it takes a year.
4) Slow tapering can still rid you of most of your trazodone-related issues. Lots of you complain of fatigue, brain fog, and issues from trazodone. Just reducing your dose a little bit is enough to significantly improve these symptoms. Don't make the mistake of thinking you will not see improvement until you're completely off of it. You're having withdrawals because your receptors have adjusted to the medication. Your baseline for "normal" has now been modified from a trazodone virgin. Even a slight reduction in trazodone will have profound effects at the receptor level and will make you FAR more "normal" than immediate discontinuation, which is going too far in the opposite direction.
5) Trazodone is "dirty." I'm constantly amazed at how little doctors know about the drug and how even reputable drug interaction checkers are downright incorrect. I honestly never had a problem with trazodone until I started taking other medication, then suddenly what had calmed me down and helped me sleep started providing me with insane anxiety, headaches, and brain fog. All interaction checkers came back with negative results, but I dug deeper and found a bunch of research showing that indeed, there were interactions with my medications. Medical literature states that trazodone is metabolized by the CYP3A4 pathway, which is correct, but what it NEVER EVER mentions is that it's dirty active metabolite, MCPP is broken down by CYP2D6, the same pipe used by a plethora of medications like Adderall, Vyvanse, Ritalin, SSRIs, Opiates, Benedryl, etc. This same metabolite causes severe anxiety, headaches, blurry vision, and a plethora of other issues. At least in my case, trazodone never gave me a problem until I started taking it with other 2D6-metabolized medications.
6) Trazodone is not just sertonergic, which is why withdrawal is so bad. If you look at the binding profile, it affects norepinephrine, serotonin, histamine, and more... The rebound histamine is responsible for a lot of the symptoms of withdrawal--the ones that closely mimic allergies such as itching, dry skin, runny nose, watery eyes, etc.
7) Just because Trazodone is horrible, doesn't mean SSRIs are. I'm going to be honest here, and this might be some advice that will be hard to swallow by a lot of you who are getting burned here. In all of my experience with depression and insomnia, nothing has ever come remotely close to being as effective as Lexapro (Escitalopram) for me. It gave me my life back TWICE now, during the roughest times of my life. It has helped me sleep better and deeper than I've slept in years without a sleeping aide. If you are taking trazodone for sleep, the chances are that your sleeping issues are serotonergic in nature. The chances are that you might actually benefit from an SSRI... Don't get me wrong, SSRIs also have discontinuation syndromes (although nowhere near what trazodone is), and the first 2-6 weeks are HELL while your body adjusts to them... But after that, at least for me, it's absolutely worth it. They gave me my life back, and that's a small price to pay for taking a little pill once a day...
I would advise to not start tapering again until you have stabilized for a few months, then decrease about 10% every three weeks or so, even slower as you get close to the end.
It has been only 1 week since I reinstated, so I intend to remain on this dosage until end of Sept, then taper over 9 months or so.
Slow taper is the ONLY WAY for most. Everyone, take note!
Okay, I just went through some pretty major withdrawals myself and spent a lot of time reading these posts looking for inspiration... and yeah, most of the people never bother coming back after they've made it through to help out the rest of us... I made kind of a pact with myself that I would. Note that this was not stopping cold turkey, this was dropping from approximately 50mg to 25mg.
Firstly, it definitely seems as though the lower doses are MUCH harder to taper off of. I remember each chunk when I was closer to 100mg was hardly noticeable. Now every depressingly small little piece I break off every so often is at LEAST a week straight of agony. Here's what to expect once you get to around 50mg and are trying for a more aggressive taper.
It takes approximately 2 full weeks to feel "approximately normal" again, and unfortunately it did not appear to be linear at all. For about a week and a half, it was basically misery, then in a short span of around 3 days, I would start to notice that it was mostly over. It'll probably be at least another week until I'm fully back to normal, and I would not attempt cutting off another chunk until I've given myself a few more weeks to normalize.
What I noticed was that the first thing that hit me was physical symptoms. I was emotionally fine, but suddenly I was having serious diarrhea, cramping, and stomach problems. I even had a hemorrhoid flare up out of nowhere that was so bad I was crapping up what looked like an entire toilet of blood, and I could barely sit down... Just to have it 100% disappear like it never happened 2 days later. Undoubtedly because of Trazodone's effect on vasoconstriction and vasodilation within the rectum and intestines. Anyway, I digress. From digestive problems, it suddenly went to EXTREME, EXTREME fatigue. Like one day I woke up and realized I could barely make it out of bed. Every muscle in my body seemed to ache and lack energy. I would lay in bed for an extra hour or two after the alarm went off, just trying to muster up the strength to move.
As time went on, the symptoms seemed to move from my body to my mind within the span of a few days. The physical exhaustion also became mental exhaustion. The brain fog was bordering on debilitation, and don't be expecting to get any kind of real work done. The worst part for me was the depersonalization. The feeling that I was either dreaming, wasn't really there, or was totally disconnected with reality. That feeling seemed to come and go over the span of about a week. Oh, during the majority of the time, I also had a low-grade fever which seemed to be completely unaffected by any OTC painkillers (Aleve, Aspirin, Ibuprofen, Tylenol--nothing helped).
The depersonalization seemed to fade away into flashes of anxiety. I started to feel much better first thing in the morning, noticing I had way more energy to get out of bed at around 1.5 weeks, but then I noticed starting at around 1-2PM, I would go from moderately productive back to severe anxiety that would kill my productivity and would put me back on the couch. It seemed as though every day this anxiety was being pushed back further and further, which make sense, as Trazodone has a very short half-life and that time seems to correspond with when most of it has left my system.
Later on the anxiety turned into more of a slight depression, but it became more manageable. I had considered going to the doctor's office, because the physical symptoms were so bad that I almost had trouble believing it was due to Trazodone and not something like the flu. The fatigue was the worst part for me. Absolutely DEBILITATING, and no matter what I did, whether I took Adderall (dextroamphetamine), caffeine, or vitamine B12, nothing could lift the brain fog or fatigue. I have never in my entire life felt an Adderall do so little for my energy or focus... Even prescription opiates like Lortab or even freaking Roxicodone BARELY did a damn thing, and that's some REALLY powerful stuff... I can confirm benzos like Xanax and Valium DO help, but I think it's just a band-aid. They very quickly build tolerance and after just a week of those two, you will start adding benzo withdrawals to the Trazodone withdrawal, and those are even worse... I wouldn't bother.
Unfortunately I was also a 100% complete health-freak during this time, eating nothing but lean meats, proteins, eggs, kale, spinach, V8s, fruits, nuts, and seeds and doing quite a bit of cardio, and it was still that bad for me. I HIGHLY, HIGHLY recommend that during this time, you also make similar health adjustments to give your body its best fighting chance. Take your vitamins, eat well, avoid MSG like the goddamn plague, as it makes the anxiety and depersonalization that much worse. I would force myself to run to the point of exhaustion maybe 4 times a week, despite the fact my body seemed to be telling me that I shouldn't... It seems as though I was right not to listen to it. It didn't hurt, and when the anxiety got bad, a good run DEFINITELY made my afternoon go better, and I think it returned my energy levels sooner.
There is some good news, though. Throughout the whole ordeal, even during the most acute phases, I would have flashes of lucidity and clarity where I felt like I could easily see that all of the brain fog, lethargy, and apathy caused by a year of Trazodone was starting to dissipate. It was those moments of finally being able to see through that mental fog that kept me going, and even made me grow to enjoy the pain of detoxing in a sick way. I could feel my brain slowly getting stronger and normalizing to before I had ever touched Trazodone. Treasure those thoughts.
Another thing I will mention is that I'm also on Lexapro, which has only ever brought me clarity and contentment while Trazodone brought fog and apathy. In preparation for the rapid detoxing, I upped my dose of Lexapro to compensate for the lower serotonin levels (and yeah, it was still that bad). While it really didn't make a difference with the majority of the symptoms, what I will say that I noticed from previous unsuccessful tapered attempts was a DRASTIC reduction in the anxiety, rage, and despair. Last times I wanted to seriously harm myself, shatter objects, and just punch things, and I'm not at all a violent person who has those kinds of thoughts. This time, there was almost no rage at all, which I can only attribute to Lexapro. Oh, and insomnia was also NEVER a symptom I had. I don't think I slept less than 7-8 hours a single day (often I was getting closer to 9-10 hours with the fatigue).
If you're on an SSRI with Trazodone, don't blame the SSRI for what is actually Trazodone, and DON'T stop the SSRI first. Let the SSRI help you come off of Trazodone. If you're one of the unlucky people who cannot ever seem to come off of Trazodone, maybe you should consider cross-tapering with an SSRI. For me, Lexapro helped with my sleep in a long-term way more than Trazodone ever helped short-term. At first it can cause insomnia, but for me, after a few weeks, it totally seemed to normalize my sleeping and helped me stay asleep far longer without taking any kind of sleeping aide. For depression and anxiety, it offered a relief to both without clouding my reality and robbing me of my drive in life as Trazodone did. They do have their own discontinuation syndromes, but as someone who has quit both Lexapro and Trazodone before, Trazodone's is WAY worse.