Is There a Connection between Trazodone and Weight Gain?

Based on clinical trials and reported side effects, there does appear to be a connection between trazodone and weight gain. Many different side effects have been reported by patients taking the drug, and weight gain did occur in both inpatients and outpatients receiving the treatment. Clinical studies appear to show that weight gain is more likely in patients taking the medicine outside of the hospital, but this may be because the patients are more able to indulge their increased appetites. Even in outpatients, less than one in 20 patients experience weight gain.

Trazodone is an anti-depressant, but the precise mechanism by which it works is not yet known. It is believed to work by blocking serotonin receptors and balancing serotonin levels within the brain. The drug comes as a tablet and is taken between one and three time per day. It does not work in exactly the same way as a selective serotonin reuptake inhibitor (SSRI), but is thought to block the reuptake of serotonin. This means the serotonin is available for the nerves in the brain.

Clinical trials conducted on the effectiveness of the drug found a link between trazodone and weight gain when compared to a placebo. While weight gain is far from the most common side effects of the drug, both inpatients and outpatients receiving the drug experienced more weight gain compared to the placebo group. The symptom is more likely to occur in outpatients, with over three times the number of patients taking the drug outside the hospital reporting weight gain. One possible explanation is that trazodone causes an increase in appetite, which cannot be completely satisfied on hospital food but can be when the patient is at home.

The precise mechanism by which drugs cause weight loss or weight gain is often not known. For this reason, it is difficult to say why trazodone and weight gain are linked as they appear to be. Some people actually experience weight loss when taking trazodone, because they no longer need to balance the brain’s serotonin levels using food. Many different biochemical processes occur in the brain, and making a chemical change can result in outcomes that are not understood. The link between trazodone and weight gain appears to be one of these.

Taking trazodone can cause weight gain, but there are several other side effects you're more likely to experience than a fluctuation in your weight. Everyone who takes this antidepressant will have a different reaction to it, and you may experience all, a few, or none of the following side effects: 

If you find yourself experiencing any of the above symptoms, it's best to speak with your physician to ensure you're taking the medication correctly and decide if there's a better option available for you.

While this medication is regularly used to treat depression, there are reports that the drug can cause suicidal thoughts and/or behavior. In fact, the medication comes with a black box label warning about this specific side effect.

Most people won't experience suicidal thoughts or behavior when taking the medication, but it's still possible. Trazodone is one antidepressant with the highest suicidal thoughts and attempt rates in adults aged 65 and older.

This antidepressant has a sedative effect on most people, so some providers utilize it for patients who have insomnia or other sleeping problems. The issue with using trazodone for insomnia is that this is an "off-label" use.

When something is considered off-label, it means that while the drug is FDA approved to treat depression, it's not FDA approved to treat insomnia, even though it might help some people with this condition. 

Since trazodone has been around for ages, most physicians know how the drug works in certain situations and, therefore, will exercise their discretion when prescribing it for insomnia or other off-label uses. Other off-label conditions doctors might prescribe trazodone for include: 

There's a lot of controversy surrounding physicians prescribing this medicine for those experiencing insomnia due to drug or alcohol withdrawal. It can be helpful, but with its sedative nature, it can become addictive, especially for those who already struggle with addiction to one or more substances.

Whatever the reason you've prescribed trazodone, knowing about the potential drug interactions you can experience while taking it is critical. Depending on what other medications you're on, you must be careful when taking trazodone since several other drugs can cause mild or life-threatening interactions. 

If you're taking any other antidepressants, especially SSRIs, SNRIs, MAOIs, triptans, any drug with dextromethorphan, or St. John's wort, you risk developing serotonin syndrome. 

Serotonin syndrome is life-threatening and can cause seizures, hallucinations, tachycardia, diarrhea, a coma, and even death in severe cases. Other drugs that can cause interactions when taken with trazodone are: 

You should speak with your doctor about possible drug interactions and how to take all your necessary medications safely. Alcohol is something you may want to avoid while taking trazodone. There's no direct correlation with adverse side effects, but combining the two substances can make you feel extra tired, dizzy, and unable to concentrate.

For those who are pregnant or breastfeeding, you need to be cautious when taking trazodone. While there aren't any official studies proving the effects trazodone has on developing fetuses or infants, high doses of the drug in animal studies show adverse effects.

The FDA classifies all medications so pregnant women know the risk level of taking them when carrying a child. According to the FDA, trazodone is considered a class C for pregnancy. 

This means that only women who absolutely need to take the medication should take it while pregnant or breastfeeding. The FDA classifies "absolutely necessary" where the medication's benefits to the mother outweigh the potential dangers to the fetus.

Animal studies suggest that trazodone can pass through breast milk from the mother to the infant. It's unlikely that it's a high enough dose to cause severe harm to the child, but prolonged, heavy use by the mother and consumption of breast milk often could cause potential issues for the child.