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Trazodone is a medication used to treat depression. It may help to improve your mood, appetite, and energy level as well as decrease anxiety and insomnia related to depression. Trazodone works by helping to restore the balance of a certain natural chemical (serotonin) in the brain.

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Trazodone is not one of the “classic” antidepressants, but like these it has been used for a long time. However, it is not used nearly as frequently as other antidepressants.
Compared to a dummy treatment, trazodone clearly improves the symptoms of moderate to severe depression. Its second property, that it makes you tired, can be used in depression with inner restlessness and pronounced sleep disorders. However, there is insufficient research into how the effectiveness of trazodone compares to other antidepressants with similar properties.
The problem is that the depressant effect of trazodone lasts during the day and then affects short-term memory, balance and muscle strength. In addition, it has a number of other undesirable effects.
Trazodone is considered “suitable with restrictions” and is primarily used when depression is associated with persistent sleep disorders and these are to be alleviated.

Trazodone and sexual function

Sexual dysfunction is very common. For the treatment of male impotence of organic and increasingly also non-organic genesis, the erectile tissue injection is mainly used. The options for treating weakened female libido are limited. Psychotropic drugs and thus also antidepressants often cause sexual dysfunctions, with attention being paid predominantly to male sexuality. Trazodone is a second-generation antidepressant, registered in 43 countries and has been on the market since 1977. In contrast to other antidepressants, trazodone seems to promote libido and erectile potency in both organic and psychogenic impotence. Case reports indicate that that trazodone can also have a positive effect on a weakened female libido.

Among other things, an anti-alpha-adrenergic-mediated delayed detumescence of the erectile tissue is responsible. There is some evidence for additional central nervous mechanisms, to which an anti-alpha2-adrenergic and anti-serotonergic component may also contribute. The clinical findings to date make a treatment attempt with trazodone in erectile dysfunction seem sensible. Even if the substance has not yet been approved specifically for this indication, the medical freedom of therapy allows its use in urology, taking into account the available literature and an individual benefit-risk assessment. In contrast to the antidepressant effect, the prosexual effect occurs even at relatively low daily doses of 50 to 150 mg and even within hours to days. The most common side effect is tiredness due to the sedative properties of trazodone, which is why the substance should be administered in the evening. Priapism must be considered as a serious but extremely rare complication (1:10,000), although this problem is to be expected much more frequently with alternative SCAT therapy.

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