Hi Christopher,
I appreciated your discussion on melatonin. It was interesting to see the list of adverse side effects, given the fact that many consider it to be mild and without risks. In a similar vein, i wanted to discuss the use of trazodone for sleep. I’ve often seen this used in clinical practice as an alternative to the use of benzos or Z drugs. In my personal experience, it seems to be considered on the "milder side" (perhaps, a step above melatonin, but below benzos/Z drugs). In an effort to decrease the frequency of prescribing benzos and Z drugs, which are associated with a multitude of risks, trazodone seems to be the next best medication option. However, trazodone is also not without it’s own set of risks.
Bossini et al. (2015) reported multiple side effects associated with trazodone. These include residual daytime sedation, dizziness, orthostatic hypotension, and psychomotor impairment. Due to these adverse effects, trazodone remains off-label for the treatment of insomnia in many countries.
Thus, this speaks to your point that there is no medication that does not have it’s own set of consequences. Using pharmacological agents (Z drugs, benzos, melatonin, trazodone, and so on) when addressing sleep should be contextualized per patient (i.e., based on their age, potential for abuse, cognitive status, risk for falls) and ideally, be used only as a short-term strategy or “bridge” while other interventions are being implemented (i.e., CBT or other alternative strategies).
References
Bossini, L., Coluccia, A., Casolaro, I., Benbow, J., Amodeo, G., De Giorgi, R., & Fagiolini, A. (2015). Off-label trazodone prescription: evidence, benefits and risks. Current pharmaceutical design, 21(23), 3343-3351.
