Dragonportal: Trazodone Stopped Working for Insomnia

[Dragonportal]

Hello Everyone,

I was prescribed Trazodone 50mgs in March of 2020 for acute insomnia (i only took 12.5mg to 25mg in the evening before bed because I am a lightweight). I used it for a year because it seemed to work perfectly with my atomoxetine (for ADHD) which I have taken at night for more than 10years. The only odd thing was that it caused a slight bit of brain fog. 

 

Suddenly in June of 2021 it stopped working and I started waking after only 3hrs of sleep. I did try increasing the dose but it didn't work. I also starting taking my atomoxetine in the AM to see if that would help. The doctor prescribed me Hydroxyzine and while that worked to get me knocked out it has a really long half life and too many side effects and next day drowsiness. But it seemed to help me wean off of the Trazodone within a few weeks.

 

I was fine off the Trazodone until about 6 weeks after I stopped taking it. The insomnia came back with a vengeance along with obsessive thoughts before bed. Through reddit and this site I discovered Magnesium. I take 200mg of Nature Made Magnesium glycinate taken 1 to 2 hrs before bed and for the past month it has helped me sleep 7-8hrs and I can fall back to sleep if I wake during the night. The sleep is not very deep but I was able to function.

 

The problem is that the benefit of Magnesium Glycinate is starting to fade a bit. I still have nights where I wake after only 2 hrs of sleep and have to take a Trazodone. Unfortunately it doesnt help me get sleep when I wake during the night. It only helps me if I havent fallen asleep yet. The next night after I have taken Trazodone I can usually sleep. I can sometimes go 2 weeks without needing Trazodone. 

 

It's a vicious cycle.

 

And to add to it, my atomoxetine which I used to take in the evening to help me sleep, now keeps me awake. I suspect it's because it acts on my NMDA receptor site. Magnesium also acts on that receptor and can cause an excitatory effect or calming effect depending on other variables. My thought is that the supplement and ADHD meds are interacting. Plus taking Trazodone for a year may have changed my brain chemistry.

 

So my question is - Has anyone else had a similar issue? Any advice? I was thinking of re-instating Trazodone and trying to taper. AND maybe experimenting with different combinations of magnesium supplementation to help me sleep. I am desperate for a solution and completely at a loss. I have never had chronic insomnia before. I have only ever had acute bouts.  

 

So grateful for this site. Hope you all are well!

 

Not sure how to add my details in signature but here they are

 

3/27/2020 started on 12.5-25mg of Trazodone for acute insomnia trouble falling asleep

6/4/2021 sudden onset insomnia (waking to early)

6/28/2021 tapered completely off Trazodone (doctor said it's fine to do that)

July to Sept - took Trazodone PRN

9/25/2021 another bout of insomnia (trouble falling asleep or waking too early)

9/25/2021 started taking Magnesium glycinate 200mg 1-2 hrs before bed

Oct- Nov- Magnesium working well

11/12/2021 - experimented a few nights taking atomoxetine in evening, magnesium closer to bedtime

failed

11/19/2021 - 2 hrs of sleep on Magnesium Glyc - took 25mg of Trazodone PRN in middle of night, didnt work

 

[Kiasofia]

Welcome @Dragonportal

I am sorry you are going through this and are suffering, but relieved you have found us. Taking Trazodone occasionally is not a good idea. Every time we start and stop a psychiatric drug our central nervous system (CNS) becomes sensitized. Withdrawal symptoms, such as insomnia, are a common consequence. Sleeping problems can also be a side effect of atomoxetine. Have you stopped using Hydroxyzine?

 

What is withdrawal syndrome?

Dr. Joseph Glenmullen's withdrawal symptom checklist

 

Was 19 Nov the last time you took Trazadone 25mg? When was the last time before that and what dose? Stopping completely is better than intermittent use, but since you were taking it daily for over a year and have been taking it as needed lately, starting to take a daily dose should be considered. Please read this to learn more:

About reinstating and stabilizing to stop withdrawal symptoms

 

This link has information on how and where to make a signature:

How to List Drug History in Signature

 

I found this post helpful to understand how these drugs actually work:

How Psychiatric Drugs Remodel Your Brain

 

About sleep and supplements:

Tips to help sleep -- so many of us have that awful withdrawal insomnia

Our symptoms and self care topics

Important topics about tests, supplements, treatments, diet

 

As we are recovering, we suggest keeping things slow, simple, and stable. This is extremely important. 

Keep it simple, slow and stable

 

Take some time to read the information I have provided and then we can take it from there. This is your Introductory topic, where you can ask questions and connect with other members.  We're glad you found your way here.

 

Please stay in touch and let us know how you are doing.

[Dragonportal]

@Kiasofia I think I figured it out, at least for now. Trazodone should be taken with a light snack to avoid side effects. Also, for maintenance insomnia (waking too early), Trazodone should be taken with fatty food to delay absorption and peak T-max C-max. In laymans terms, you might sleep 7.5 hrs vs 5hrs with that simple trick. It's in the literature you receive when it's prescribed. Why no one suggested this, I have no clue. I stumbled across a you tube video where the med student posted a pic from a page of a textbook showing section discussing Trazodone. Thank you so much for reaching out. I will keep you all updated. I am going to probably start a taper in the next few weeks to a month starting from 18mg I took last night. I am not taking hydroxyzine anymore. 

 

3/27/2020 started on 12.5-25mg of Trazodone for acute insomnia trouble falling asleep

6/4/2021 sudden onset insomnia (waking to early)

6/28/2021 tapered completely off Trazodone (doctor said it's fine to do that)

July to Sept - took Trazodone PRN

9/25/2021 another bout of insomnia (trouble falling asleep or waking too early)

9/25/2021 started taking Magnesium glycinate 200mg 1-2 hrs before bed

Oct- Present- Magnesium glycinate 250mg working well

11/12/2021 - experimented a few nights taking atomoxetine in evening, magnesium closer to bedtime

failed

11/19/2021 - 2 hrs of sleep on Magnesium Glyc - took 25mg of Trazodone PRN in middle of night, didnt work

11/24/2021 - 18mg Trazodone working again

 

 

[Kiasofia]

Good, hopefully that will help with side effects. Make sure to take the same dose at the same time every day and then taper from there. Information on tapering:

Why taper by 10% of my dosage?

NEVER SKIP DOSES TO TAPER

Tips for tapering off trazodone (Desyrel)

 

Be aware that the lower doses are harder to taper than higher doses. This explains why: 

Why taper? Importance of gradual change in plasma concentration

 

Please put your drug history in your signature so it’s easy for anyone reading your posts to get a quick overview of your situation:

Create Your Signature in "Account Settings".

 

As mentioned, this is your Introductory topic, where you can ask questions and connect with other members.  If you need any advice specific to you and your situation, please ask it here. Otherwise, feel free to join discussions on other threads. To make sure I or someone sees your question, tag them by writing @ and then start typing their username. A drop down menu will appear. Click on their username and it will turn blue.

 

Best wishes for your recovery and please update us on how you are doing.

[Dragonportal]

@Kiasofia Thank you for the quick reply. Just to note as a clarification, Taking Trazodone with food delays absorption and extends the sedative effective for me from 5 to 7hrs. That was the missing piece. I wasn't having side effects taking it without food. Actually I am now having next drowsiness as a result of the delayed absorption, but if that is the only price I have to pay, I will take it.

 

During my 2 mos cold turkey withdrawal, I suffered from a lot of DPDR and increased anxiety, insomnia and when I did sleep my sleep was decreased and not deep enough. There is no question Trazodone has caused long term effects to the sertonin receptors in order to accommodate the drug. 

 

One other note, Trazodone is not an SSRI, so would the advice on tapering SSRI's still apply the same to Trazodone? Just curious.  

 

@brassmonkey I heard you might be able to recommend (in real time - i know brands change quality) a scale under 400$ capable of measuring ground up Trazodone powder to below 1mg? I need to measure to a low dose of 0.36mg per my excel spreadsheet. That will be 2% of the original dose.

 

Once again I am so grateful this site exists. I feel so validated in my struggle. And thank you again @Kiasofia

[Dragonportal]

Feeling DPDR and lack of emotion this evening. Trazodone doesnt usually linger in my system as a hangover the next day. I wonder my body is reacting differently to the medication after 3mos of taking it sporatically/PRN.

[Kiasofia]

Does that mean you are able to sleep better now? Sorry to hear about the DPDR. It's awful, but know that it is common and will pass.

 

Did you get a chance to read this post?

How Psychiatric Drugs Remodel Your Brain

 

This is also worth reading:

The Windows and Waves Pattern of Stabilization

 

How long the drug is in our system is only a part of how it affects us since it is also changing the brain and it takes time to change back.

 

16 hours ago, Dragonportal said:

One other note, Trazodone is not an SSRI, so would the advice on tapering SSRI's still apply the same to Trazodone?

Yes, because just like SSRIs the brain has adapted to the drug and needs time to get back to its normal state. It is not well understood how these drugs actually work on receptors and which receptors are actually being affected. But they are being affected and need the time adapt to the absence of the drug.

 

I highly recommend reading  Anatomy of an Epidemic by Robert Whitaker as well as A straight talking introduction to psychiatric drugs by Joanna Moncrieff to better understand these drugs and their effects. The Council for Evidence based Psychiatry also has a lot of good information.

[Dragonportal]

I need to figure out how to quote...I am sleeping deeper and a little better, but feel drugged unfortunately. Here is a summary of last night from my journal:

 

Thanksgiving. Made stuffing ahead last night. Wasn’t taking my supplements at the same time. Definitely off schedule. I ate about 20min before taking my trazodone. I slept from about 11:45pm until 5am, waking with the strong urge to pee. My side hurt after I peed maybe because my bladder backed up?? I was awake until I think 6am and then fell back to sleep until my alarm went off. Wow?! I cannot remember the last time I had to be awakened by an alarm - Probably 5mos ago. So that was about 6hrs of sleep. And it’s deeper sleep than I was having during my 2 mos withdrawal period from Trazodone. Feeling groggy today evening on 2 cups of coffee. And my neck hurts. Some brain fog. Some brief crying.

 

Still taking atomoxetine in the AM but might try to switch back to evening when my body gets used to the trazodone again. Believe it or not atomoxetine is sedating when I take it. It's not a stimulant it's an NRI and has always had that affect for me. BUT I have found through experimentation that magnesium interacts with atomoxetine if doses are taken close together in the evening and causes stimulation - i basically feel high and chill but wide awake lol... sooo not sure how to deal with that. Taking atomoxetine in the am is not out of the question...

 

I am panicking a bit too, feeling trapped by the drug. I just want to go back to before I started taking Trazodone. 

 

Happy Thanksgiving everyone!! About to visit family I havent seen in 2 years since covid. Feels like a lifetime ago.

[Kiasofia]

14 minutes ago, Dragonportal said:

I need to figure out how to quote

Highlight what you want to quote. A box will appear saying "Quote selection". Press on it.

 

This also notifies the person who wrote it the same way tagging does @Dragonportal

 

For now I think the best is to give yourself a few weeks of no changes since you just started taking Trazodone regularly.

 

Keep it simple, slow and stable

 

19 minutes ago, Dragonportal said:

. BUT I have found through experimentation that magnesium interacts with atomoxetine if doses are taken close together in the evening and causes stimulation

But now you take atomoxetine in the morning and magnesium at night? Does that help?

 

Hope you have a nice Thanksgiving!

[Dragonportal]

On 11/25/2021 at 12:13 PM, Kiasofia said:

But now you take atomoxetine in the morning and magnesium at night? Does that help?

 

During my cold turkey withdrawal, yes the change was helpful and noticeable. Now that I am back on Trazodone I don't know if it makes a difference. Not going to try to change though. My nervous system is not happy so will hold off.

 

Here is my journal entry from yesterday

 

Last night I slept from 10:30pm to 6:15am. I woke feeling great, and rested though very adhd and not motivated to exercise etc. But after a while I felt detached and unreal. It’s 10am. Wondering if taking the atomoxetine in the daytime is sedating me too much along with the trazodone hangover. Now knowing that I need to take trazodone with food, I might be able to go back to taking atomoxetine at night. Definitely an experiment I need to try.

Also interesting is that I felt my best around 6:30pm last night, a little wine in my system. As the trazodone wore off I felt like myself again and was so tempted to not take it last night. I ended up taking 14mg of Trazodone ish of it. I am breaking the pill so no idea how much I am getting. But I wonder if there is a cumulative effect when I take it consistently so that I don’t need to take as much.

 

And last night:

 

Last night was obsessing over medicating normal documentary listening to podcasts on youtube. I was worried I wouldn’t be able to sleep but the trazodone knocked me out from 11pm to 2:15am and then slept til 6:30am. I felt drugged in the am and not motivated but rallied and got up.

 

I ordered the Gemini -20 scale. I am thinking my pill weighs enough to allow me to taper using the powder method. 

 

I am so saddened by the state of our mental health care system. I will always need atomoxetine. But I think there needs to be more information given to patients about the potential for physiological dependence on the drug. 

 

Thanksgiving was good. Thank you for asking. Human connection is everything <3.

[Dragonportal]

I will need to reduce my re-instatement dose. I am experiencing severe brain fog on 7 days of approx 14-18mg ( I don't have my scale set up to measure yet). Definitely having an effect on my work and daily tasks. But it makes sense since I was doing well on 12.5mg for over a year. I am sensitive to the med after a 2 month break from it. Going to try 8mg and maybe 6mg to see what keeps me asleep with out the side effects. Also might try to start taking atomoxetine at night again. I just need to stop taking the mag glyc and maybe take a morning mag supplement instead. This is the worst issue I have had with a med. Never again.

[Dragonportal]

Update - I finally got a mg scale. I reduced my dose to 3mg and have been taking that dose for 3 nights now. I think I might have been taking 10 to 12mg before. Anyway, pill weight is 40mg. This seems to be the magic dose that keeps me sleeping through the night without causing next day drowsiness. I need to take it with food though. Last night I forgot to take with food AND I took the atomoxetine at night. I did not sleep deeply AND I woke up sweating. Got about 5hrs of sleep. I might take the atomoxetine with dinner, around 5 or six pm. Will see if that works better.

 

Thanks for reading. Hope everyone is hanging in there and finding time to enjoy the weekend!

 

[Kiasofia]

I hope you continue to feel better on 3mg. I would hold there for at least 4 weeks. Make sure to stick to a schedule and take the different drugs at their set time each day.

[Dragonportal]

Thank you! So far it seems when I am stressed on this 3mg dose, I only get 4 to 5 hrs of light sleep. Though I slept 9hrs Sat night and felt great on Sunday. I have only been taking the lower dose for about 4 nights, so still wait and see. Noticing I have very little daytime side effects which is perfect. 

 

Last night I only got 4 to 5hrs of very light sleep so I am very detached today and cannot feel my emotions as much. Hoping for a better night tonight.

[Dragonportal]

Well I have had some really good stretches of sleep, up to 15 days at 7.5hrs of sleep average a night. Last stretch over the holidays was 7 days. Just prior to Christmas I had a 5 day stretch of days where I only slept 5hrs a night. I figured out it was because I needed to pee. So I got in the habit of not drinking anything at least 2hrs before bed and that seems to do the trick. 

 

I also started taking magnesium malate for muscle tightness. I take 200 per day in 2 doses at breakfast and at lunch. Seems to help. And I continue to exercise 1 to 2 times per day. I might start drinking half caffeinated coffee in the am to help cut down on my total caffeine intake. I continue to take atomoxetine around 7pm every night. That helps to relax me before bed.  

 

All that said, it is still a battle trying to come off this drug. I am nervous about starting a taper since my sleep is not yet ideal. Also, I seem to sleep better in the winter so a part of me just wants to stay on the drug until spring so I can "catch up" on my sleep. 

 

Overall, it's just been great to be off from work for the holiday. I really needed this break after suffering for the last six months. My last week off was in the summer.

 

I am holding onto hope that things will get better. 

 

Hope everyone had a wonderful Christmas and wishing everyone a happy new year as well!!

[Kiasofia]

I'm very glad to hear you are getting more sleep. Doing a longer hold until spring is not a bad idea. What side effects are you having from it now?

 

How long have you been taking Dexilant?

Tips for tapering off stomach acid blockers or PPIs...

Edited December 30, 2021 by Kiasofia
added question and link

[Dragonportal]

Thanks for the quick reply. So as far as symptoms, I have DPDR when in social situations. Social anxiety and dizziness are other side effects I notice. I have bouts of depression as well.

My New Years plans also got derailed because of Covid. A family member we were around on Christmas and a few days after, has Covid and is symptomatic along with one other family member. So that could be contributing to the depression. In general, I just have a lot of mental fatigue and I just feel off and not myself. 

There is also cognitive sluggishness at times. I do have ADHD but I am high functioning so the sluggishness seems out of norm and also seems to correlate with nights that I have not gotten at least 7hrs of sleep.

[Kiasofia]

I'm sorry your plans got derailed😔

 

How long have you been taking Dexilant? Dizziness is a possible side effect as well as depression. You might want to consider tapering off it as soon as possible.

That acid reflux pill may be causing your health problems

Tips for tapering off stomach acid blockers or PPIs...

[Dragonportal]

@Kiasofia Thank you for this tip. I haven't yet started tapering the micro-dose of Trazodone I am taking (3mg) but I since the end of November I have been tapering the Dexilant. I started at 60mg and am now done to 10mg which I will take til the end of the week. I am experiencing chills which leads to me to suspect the drug might be causing an iron deficiency as well as depression. Can't wait to be off it!

 

I am still struggling a bit with sleeping issues, but my sleep quality has been much better on the micro-dose of Trazodone than when I was going through withdrawal. I would say I am averaging about 6.8hrs of sleep a night if I don't count the nights when my sleep is disrupted by having to pee or stress response from previous days events.

[Dragonportal]

Not sure if it's because I only slept 4hrs last night, but I am feeling depressed right now. I should be fine once night time comes but it's so hard. I wonder if Trazodone withdrawal is known for causing depression or if it's the PPI.

[Kiasofia]

Good to hear you have been tapering the dexilant. It is hard to say what is causing depression, but it is a common withdrawal symptom.

[Dragonportal]

Hello, I am off the Dexilant now. It's been about 3 weeks. And I just had an amazing sleep last night. I slept 9 and a half hours. Haven't done that since early 2020 at least. That, after getting only 3hrs of sleep the night before. My sleep prior to that has been averaging about 6.75hrs of sleep if I don't include the ocassional nights that I get 3 to 5hrs of sleep. I am used to getting longer amounts of good REM sleep so sleep quality has only been back to normal 4 nights over a 3 month period. 

 

Of note I found out that the pill weight of Trazodone is variable. The average pill weight is 279 to 286 mg. So my estimate that I was taking 3mg is not accurate. I believe it to be more like 7 to 7.5mg. 

 

I tried Magnesium Malate & Magnesium Carbonate (Calm) and found out that Magnesium Malate did nothing and Magnesium Cabonate (Calm) though it took away my early morning cortisol spike completely which allowed me to get back to sleep in the middle of the night, the price for that was awful constipation and stomach cramps. I might just stick to my kale smoothies and also watch my added sugar intake.

 

Still wary about starting the taper but I have gotten a few good long deep sleeps, and hope to have a few more under my belt in the near future to give me confidence to begin.

 

 

[Kiasofia]

Congratulations on getting off and I'm so glad to hear you've gotten some good sleep.

[Dragonportal]

Hello,

Just wanted to update you all. I am down to 9mgpw of Trazodone which is about 1.60mg of the drug (note, originally had wrong pw to mg exquivalent - see attached spreadsheet). I got to that dose by following the recommended 10% incremental dose reduction recommended by this wonderful community. I am measuring that dose on a milligram scale. I have been progressively sleeping better over the last 11 months with just one major sleep regression when I was sick with COVID in Sept. I am thinking of hopping off of the medication in the next month or so.

 

Currently I sleep 7 to 8hrs per night. Now when I wake sometimes to pee, I can fall back to sleep without any issue. Would love to know how to add my story to one of your success stories. Please let me know of outline and how I can be most helpful. Thank you!!

Trazodone Taper Feb to Jan 2023.xlsx

[littlebird]

So happy to hear of your success story! Thank you for sharing this good news and giving us all some hope. Glad you're doing well!