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Unread 08-12-2017, 01:04 AM   #1
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Default Trazodone & Combining meds +Anxiety worsened by sedating meds

Hi! I meant to do some searching since I'm guessing trazodone's been talked about, being an older med and all, but I know a lot of info online is about it being used for sleep.
I recently quit Nardil and have been looking for a new med, and had also considered mentioning trazodone to my pdoc just at a low dose for insomnia. At my last appointment, mainly because we couldn't decide on something else, he decided that I should try trazodone at a higher dose...as in, for depression and anxiety, too. I'm not super hopeful about it, but since it's a kind of unique med and I have bad luck with a lot of antidepressants, I decided why not. These first few days even my starting dose knocks me out and makes me want to sleep all day, but of course that might change. Sedating meds don't tend to work well for me, though, so I've already been iffy.

Still, I'm trying it for now but guessing even if it helps some and I stay on it, I'll probably want to consider adding another med to it. A lot of the time I'm stubborn about not wanting to take multiple meds, but had finally decided maybe I'd try one of the combos that can be done safely, like SSRI+tca (I think?) or something. Before my appointment I'd been considering Prozac (because despite eventually hating it, when I took it years ago it was one of the few meds I've tried that helped me a bit), a few different TCAs, or amoxapine. Right now I'm on 200 mg Lamictal, and will probably be at 100 mg of trazodone or possibly a higher dose

Has anyone had any luck with trazodone, for anxiety/depression? Also, has anyone ever combined trazodone with any other meds that worked well?

Has anyone ever tried a tca+other med combo, or had really good luck with any tca's general? Or, even, has anyone tried any sort of unique combos that've worked really well (w/o any APs)?




And just because this trazodone thing has brought it to my mind, I want to ask one more thing. Despite having severe anxiety, it seems like a lot of sedating meds don't work well for me and sometimes make me feel worse, including meds that seem to work well for others with anxiety. In some cases, like with klonopin or seroquel, I think it's at least partly because it worsens my depression so feeling negative makes the anxiety worse. There have been others though where it just seems like being sedated and slowed down makes me anxious.
Meds that are too stimulating make my anxiety worse too though, of course. Wellbutrin seemed like it could've helped my anxiety in some ways just by feeling more positive, but it was definitely too much. Some stims actually seem to help my anxiety a bit especially at first, but the physical anxiety (especially when I'm in public) gets worse. It almost feels like maybe there's a balance, where if my thoughts are too fast I'm anxious, but if they slow down too much it's almost easier to get anxious and focus on anxious thoughts?

Does anyone else get worse anxiety from meds that make them feel sedated or tired?

Last edited by kkrrhh; 08-12-2017 at 01:17 AM.
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Unread 08-12-2017, 01:40 PM   #2
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Default Re: Trazodone & Combining meds +Anxiety worsened by sedating meds

Trazadone gave me panic attacks every time I took it. I took it three times then threw it away. YMMV
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Unread 08-12-2017, 03:34 PM   #3
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Default Re: Trazodone & Combining meds +Anxiety worsened by sedating meds

Trazadone works really well for some people. I had a very frightening experience with it, personally. I took the recommended dose and I don't know if it interacted badly with other meds, or what...I felt like I had overdosed...flashing lights, heart racing, a 'spinning' sensation, a feeling of terror. I truly thought I might die. I threw the stuff away.
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Unread 08-13-2017, 03:01 AM   #4
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Default Re: Trazodone & Combining meds +Anxiety worsened by sedating meds

Eek, sorry you both had such bad experiences. Out of curiosity, Laurie, how long had you been on it when that happened?
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Unread 08-13-2017, 07:44 PM   #5
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Default Re: Trazodone & Combining meds +Anxiety worsened by sedating meds

Thank you. Yeah, it was really a scary event. I had been taking the Trazadone for only a few days, maybe 4 or 5.
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Unread 08-13-2017, 10:39 PM   #6
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Default Re: Trazodone & Combining meds +Anxiety worsened by sedating meds

Wellbutrin is an NE and DA reuptake inhibitor. I have used it and the effects on norepinephrine was very stimulating. I had to take the XL at 150 mg. I was on two other meds. at the time and with adjustments it worked well.
Here are links for norepinephrine and one for the pharmacological proprieties of Wellbutrin
https://www.drugs.com/mtm/norepinephrine.html
Wellbutrin XL (Bupropion Hydrochloride Extended-Release): Side Effects, Interactions, Warning, Dosage & Uses

TCAs often cause drowsiness, depending on which one is used and the dose.
Here is a link to Tricyclic antidepressants-
http://www.bpac.org.nz/BPJ/2006/Dece...pages22-23.pdf

Concerning Trazadone (SARI)-
Trazodone was originally supposed to be utilized as a relatively safe anti-depressant. Basically targeting the 5-HT receptors/SERT including the 5HT2C receptor. The problem with Trazadone as an effective antipressant; the therapeutic dose is around 200-300mg. The issue is at that level the anticholgenic makes people very sedated and thus it's use as a conventional SSRI type antidepressant was limited. It has found its niche as an effective and generally safe sleep medication using doses of 25-100mg without the physical tolerance and addictive qualities of the Z drugs and benzodiazepines. These target and bind to the GABA subreceptors. Which will over time increase intolerance as GABA receptors die off unless these meds. are used cautiously for a very short time or a strict prn.
Quote:
Because of its lack of anticholinergic side effects, trazodone is especially useful in situations in which antimuscarinic effects are particularly problematic (e.g., in patients with benign prostatic hyperplasia, closed-angle glaucoma, or severe constipation). Trazodone's propensity to cause sedation is a dual-edged sword. For many patients, the relief from agitation, anxiety, and insomnia can be rapid; for other patients, including those individuals with considerable psychomotor retardation and feelings of low energy, therapeutic doses of trazodone may not be tolerable because of sedation. Trazodone elicits orthostatic hypotension in some patients, probably as a consequence of α1-adrenergic receptor blockade. Mania has been observed in association with trazodone treatment, including in patients with bipolar disorder, as well as in patients with previous diagnoses of major depression. Compared to the reversible MAOI antidepressant drug moclobemide, significantly more impairment of vigilance occurs with trazodone.[25]
https://en.wikipedia.org/wiki/Trazodone
Here is a throw off blog. I found from 4/17 . It's not a pubmed study but does mention a study of trazodone used with another medication to help with Alzheimerís, Parkinsonís, and MS. This study was done on mice and is a conjecture of the findings-
https://www.psychologytoday.com/blog...in-wonder-drug

So, there's the conundrum of neuropsychopharmacology. It is far from being an exact science and can be a maze of trial and error. Especially when you mix more medications in the stew.
There are advances being made in various fields including genome and technology-
https://www.nimh.nih.gov/health/topi...nt/index.shtml
Etiology in psychiatry: embracing the reality of poly-gene-environmental causation of mental illness - Uher - 2017 - World Psychiatry - Wiley Online Library

There are additional ways of dealing with certain mental illness- psychology (CBT and ACT), nutrition, exercise, proper sleep, and certain supplements are being used and studied but I won't bog this down anymore

Hope some of this helps and you can talk to your pdoc/mental health team about all of the options! : )
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Last edited by metamorphosis12; 08-13-2017 at 11:15 PM.
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Unread 08-14-2017, 04:30 AM   #7
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Default Re: Trazodone & Combining meds +Anxiety worsened by sedating meds

Trazodone metabolizes into a organic compound that is psychoactive and can cause anxiety. It is quickly metabolized into a benign one, but if you are a slow metabolizer it wil take more time for your body to eliminate it and may cause you troubles. This psychoactive compound is metabolized by CYP2D6, the same isoenzyme that metabolize most of AD except bupropion (I don't know about MAOI). It is the main metabolizer enzyme of SSRI, SNRI and TCAs. If you take them together the enzyme will be to busy to metabolize either the AD or the psychoactive compound of trazodone, so you are more likely to get side effects.

Have you tried gabapentin, pregabalin, old antihistaminics, benzos with antidepressant proprieties or antipsychotics with antidepressant proprieties that are not as sedative as seroquel is?
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