What are the reactions after discontinuing trazodone?

Trazodone is commonly used to treat depression and insomnia. Abrupt discontinuation after long-term use can easily trigger withdrawal reactions, including rebound sleep disturbances, intensified mood swings, neurological discomfort, gastrointestinal symptoms, and recurrence of anxiety. A detailed analysis is as follows:

1. Rebound sleep problems: After stopping the medication, previously improved insomnia symptoms may rapidly recur, manifesting as difficulty falling asleep, frequent awakenings during the night, and early morning awakening. In some individuals, sleep quality may even become worse than before treatment, significantly affecting daytime alertness and functioning. This rebound effect is primarily due to the sudden loss of the drug's regulatory influence on sleep.

2. Worsened mood fluctuations: Emotional stability decreases, leading to irritability, anger, and episodes of depression. Individuals may become highly sensitive to minor stressors, experiencing emotional breakdowns from slight triggers and having difficulty self-regulating. These changes are closely related to the abrupt interruption of the drug’s modulation of neurotransmitters.

3. Neurological discomfort: Common symptoms include dizziness, headache, and blurred vision. Some people may experience tremors in the hands and feet or sensory abnormalities such as numbness and tingling sensations in the limbs. These effects result from the central nervous system suddenly losing the drug’s inhibitory effects, leading to abnormally increased excitability.

4. Gastrointestinal reactions: Gastrointestinal dysfunction may occur, presenting as nausea, vomiting, abdominal pain, and diarrhea. Some individuals may experience a sharp decrease in appetite or indigestion. These reactions are typically stress responses to the sudden removal of the drug and usually subside gradually as the body adapts.

5. Recurrence of anxiety symptoms: If anxiety was present before treatment, anxiety symptoms may reappear after discontinuation, manifesting as restlessness, palpitations, chest tightness, and excessive worry. In severe cases, this can impair normal work performance and interpersonal relationships, creating a vicious cycle involving both emotional and physical distress.

Tapering off trazodone should follow a gradual, stepwise approach under medical supervision, with slow dose reduction to allow the body sufficient time to adjust. During the discontinuation period, family members should closely monitor the patient’s condition and provide emotional support.