Does Trazodone need to be tapered off like other SSRI's?

[bisell26]

I'm doing some work in a clinic with recovering susbtance abuse patients and many of them have PTSD due to extensive abuse. Many of them have never been tried on Prazosin but instead were on Trazodone with little benefit (300-400 mg). I find it hard to believe one can't sleep with such a high dose of Trazodone, but this is a common complaint I get. I'm thinking to switch them to Seroquel or Prazosin to help them stay asleep. Do I need to taper off the Trazodone (300-400mg) over a couple of weeks, or can I just do it over a few days?

Thanks

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[wolfvgang22]

I would taper it, though I have had patients stop Trazodone up to 300mg on their own with no taper all the time with no issues. I rarely see discontinuation syndrome that is very bad except with paroxetine and venlafaxine. Tapering or cross tapering seems to have a placebo effect with some of my patients, too. They seem to feel like they are doing something, in addition to the benefits of medication.

 

[clausewitz2]

I would taper it, though I have had patients stop Trazodone up to 300mg on their own with no taper all the time with no issues. I rarely see discontinuation syndrome that is very bad except with paroxetine and venlafaxine. Tapering or cross tapering seems to have a placebo effect with some of my patients, too. They seem to feel like they are doing something, in addition to the benefits of medication.

I have had two relatively laid back people complain of mirtazapine withdrawal after having been on a high dose for years and having it stopped all of a sudden so now I warn people about it. Would still taper, especially for complex trauma types who are going to struggle with unusual somatic sensations.

As far as prazosin and trazodone go, porque no los dos? This would allow a very slowly taper while not depriving patient of benefits of prazosin. Their mechanisms don't overlap that much.

The thread title is making my pedant self twitch, trazodone is no kind of SSRI.

 

[MacDonaldTriad]

For Trazodone to be an antidepressant doses need to be 400mg - 600mg. I doubt anyone will have much trouble coming off of 300. Trazodone is a heterocyclic and although not as cardio toxic as TCAs, unlike SSRIs, it will kill you.

 

[ryerica22]

I have had two relatively laid back people complain of mirtazapine withdrawal after having been on a high dose for years and having it stopped all of a sudden so now I warn people about it. Would still taper, especially for complex trauma types who are going to struggle with unusual somatic sensations.

As far as prazosin and trazodone go, porque no los dos? This would allow a very slowly taper while not depriving patient of benefits of prazosin. Their mechanisms don't overlap that much.

The thread title is making my pedant self twitch, trazodone is no kind of SSRI.

I don’t want them to become orthostatic as I have seen trazodone cause orthostasis before and I don’t wanna make it worse with adding prazosin

 

[J ROD]

I would probably do a quick taper. But I do not believe you have to.

 

[clausewitz2]

I don’t want them to become orthostatic as I have seen trazodone cause orthostasis before and I don’t wanna make it worse with adding prazosin

So start at 1 mg of prazosin, make sure to emphasize getting up slowly, and have them decide if they can put up with this once they've taken 3-4 doses (the first couple doses are not a reliable indicator of long-term anti-adrenergic side effect severity, too many people panic during this phase and stop what might have turned out to be a very effective and tolerable drug). The nice thing about prazosin is that the dose range is wide for this indication so you can titrate right up to the point of problematic orthostasis and then take one step back.