Trazodone alternatives: smarter choices for sleep and mood

Many people end up on trazodone because it helps with sleep, but it’s an antidepressant with side effects you might not want long-term. If you’re waking groggy, dealing with daytime sleepiness, or worried about rare but serious risks, there are clear options to consider. Below I lay out practical alternatives—both drug and non-drug—so you can talk to your doctor with a plan.

Medication alternatives worth discussing

Mirtazapine (Remeron) often shows up on lists because a low dose can help you sleep and boost appetite. It’s useful if insomnia comes with poor appetite or anxiety, but watch for weight gain. Doxepin (Silenor) at very low doses is FDA-approved for insomnia and usually causes less next-day grogginess than trazodone. Amitriptyline or low-dose nortriptyline can help with sleep, especially when pain or migraines are also a problem—but they can cause dry mouth and constipation.

For people focused on depression rather than sleep, classic SSRIs (sertraline, escitalopram) and SNRIs (venlafaxine, duloxetine) are first-line choices. They don’t sedate like trazodone, so if sleep is the main issue you might combine them with a targeted sleep treatment. Bupropion is an option when you want an antidepressant that won’t make you sleepy; it can even increase energy, so it’s not ideal for those with insomnia.

Non-habit options for sleep and practical tips

If the goal is better sleep, consider CBT-I (cognitive behavioral therapy for insomnia). It often beats pills for long-term results and removes the switching-and-tapering cycle. Medication options that specifically target sleep include ramelteon (a melatonin receptor agonist) and the newer orexin antagonists like suvorexant; these treat sleep without the antidepressant effects and usually have predictable side effects. Over-the-counter melatonin can help short-term—start with a low dose (0.5–3 mg) an hour before bed.

Practical tips: don’t stop trazodone suddenly—work with your prescriber on a slow taper if you switch. List all your meds (including OTC and supplements) before changing anything; trazodone interacts with several drugs. Try behavioral changes at the same time: set a strict wake time, limit screens an hour before bed, avoid late caffeine and heavy evening meals. Small changes add up fast.

How to pick? If you need sleep and weight gain isn’t a concern, mirtazapine could be helpful. If you want a sleep-specific pill with less morning fog, ask about low-dose doxepin or ramelteon. If mood is the main issue, ask about an SSRI or SNRI and pair it with CBT-I for sleep.

Bring this list to your next appointment. A clear preference (sleep-first vs mood-first) makes the decision easier and helps your clinician suggest the safest, most effective option for your life.