Trazodone is a well-known antidepressant that’s often prescribed to treat major depressive disorder and insomnia. While lower doses are commonly used for sleep, 400mg of trazodone is considered a high dose and typically reserved for serious cases of depression. But what does taking 400mg mean for you—or someone you care about? Is it safe, effective, and what side effects should you expect?
In this article, we’ll explore the uses, effects, and safety of 400mg of trazodone, so you can better understand its role in treatment plans.
What Is Trazodone?
Trazodone is a prescription medication that belongs to a class of drugs called serotonin antagonist and reuptake inhibitors (SARIs). It works by increasing the amount of serotonin in the brain, which helps improve mood, sleep, and emotional stability.
While originally developed as an antidepressant, trazodone is now widely prescribed off-label for conditions like:
- Insomnia
- Anxiety disorders
- Chronic pain
- Post-traumatic stress disorder (PTSD)
Why Would Someone Be Prescribed 400mg of Trazodone?
A Higher Dose for Severe Depression
The standard dosage for depression ranges from 150mg to 300mg per day, typically divided into two or three doses. However, in more severe or treatment-resistant cases, doctors may increase the dose to 400mg or even up to 600mg under close supervision.
This higher dose is usually only prescribed when:
- Lower doses haven’t been effective.
- The patient is under psychiatric care.
- There’s no significant risk of drug interactions or severe side effects.
Important: 400mg of trazodone should only be taken under the guidance of a healthcare provider.
How Is 400mg of Trazodone Administered?
When prescribed 400mg per day, trazodone is typically taken in divided doses—for example, 200mg in the morning and 200mg at night. This helps maintain steady levels in the bloodstream and reduces the likelihood of side effects.
Tips for taking trazodone safely:
- Always take with food to enhance absorption and minimize stomach upset.
- Do not crush or split extended-release tablets.
- Follow your doctor’s dosing schedule closely.
Potential Side Effects at Higher Doses
As the dose of trazodone increases, so does the risk of side effects. While many users tolerate trazodone well, 400mg is more likely to cause adverse reactions, including:
Common Side Effects
- Drowsiness
- Dizziness
- Dry mouth
- Blurred vision
- Fatigue
- Nausea
Serious Side Effects
- Irregular heartbeat (arrhythmia)
- Priapism (prolonged erection in males)
- Seizures
- Serotonin syndrome (a potentially life-threatening condition)
If any of these occur, seek medical attention immediately.
Is 400mg of Trazodone Safe?
Trazodone can be safe at 400mg, but only when carefully monitored by a medical professional. It’s not suitable for everyone—especially individuals with:
- Heart conditions
- Liver or kidney problems
- A history of seizures
- Other medications that affect serotonin levels
Your doctor will weigh the benefits vs. risks before prescribing this dose. Regular check-ins and possibly EKG monitoring may be recommended.
Drug Interactions and Precautions
At higher doses, trazodone is more likely to interact with other medications. Be cautious if you’re taking:
- SSRIs or SNRIs (like fluoxetine, sertraline)
- MAO inhibitors
- Antihistamines
- Sedatives or alcohol
These combinations can increase the risk of serotonin syndrome, excessive drowsiness, or even dangerous changes in heart rhythm.
Always inform your doctor of all medications and supplements you’re taking.
Tapering Off High-Dose Trazodone
If you need to stop taking trazodone, especially at 400mg, don’t quit cold turkey. Abruptly stopping can cause withdrawal symptoms like:
- Anxiety
- Insomnia
- Irritability
- Flu-like symptoms
Instead, your healthcare provider will create a gradual tapering schedule to reduce the dose safely over time.
Alternatives to 400mg of Trazodone
If you’re not responding well to trazodone at high doses, other treatment options may be explored:
- Other antidepressants: SSRIs, SNRIs, or atypical antidepressants
- Cognitive behavioral therapy (CBT)
- Lifestyle changes: exercise, diet, sleep hygiene
- Combination therapy: trazodone + another medication
Finding the right treatment often requires trial and error, but many people do eventually find relief.
Final Thoughts: Should You Be Concerned About Taking 400mg of Trazodone?
While 400mg of trazodone can be an effective treatment for major depression, it’s a high dose that carries a greater risk of side effects and drug interactions. If you or a loved one is prescribed this amount, ongoing monitoring and communication with your doctor are key.
Everyone reacts differently to antidepressants, so what works for one person may not work for another. The most important thing is to work closely with a healthcare provider to find a treatment plan that’s both safe and effective.
Abraham Finley is a health writer passionate about providing clear, reliable information on Trazodone and mental health. He created TrazodoneSUC.com to help readers make informed decisions about their well-being.