Ambien vs Trazodone: What’s the Difference?

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Ambien (zolpidem) is an FDA-approved sedative/hypnotic. Trazodone (Desyrel) is an antidepressant. Both medications are used to treat insomnia. People with insomnia experience an inability to fall asleep, stay asleep, or have restful sleep.

Zolpidem is approved to treat insomnia, while trazodone is prescribed to treat insomnia off-label at lower doses. A drug that’s prescribed off-label is a drug that’s approved for one condition but can treat other conditions as well.

All About Trazodone (Desyrel)

Trazadone is approved for use as an antidepressant. Nevertheless, it’s most often used as a sleeping medication. Trazodone intervenes in brain chemistry by affecting and enhancing the activity of serotonin (reuptake inhibitor) and histamine, two neurotransmitters that influence how a person feels.

The drug makes people feel drowsy, hastens the onset of sleep, and helps to maintain an uninterrupted and sound sleep throughout the night. Because trazodone is an antidepressant, it can be especially effective for people with insomnia who are also experiencing depressive mental health disorders.

In a 2008 study, researchers identified sleep disorders, including insomnia and hypersomnia, as core components of major depression. Almost 75% of the depressed patients in the study reported having insomnia.

The researchers also learned that 40% of the younger patients and 10% of the older patients experienced hypersomnia. This sleep disorder is an inability to stay awake during the day regardless of how many hours a person sleeps at night. Patients in the study with hypersomnia were predominantly female.

Sleep problems have a profoundly negative impact on quality of life, so much so that depressed people with insomnia or hypersomnia are at risk for suicide. Moreover, disordered sleep patterns can be highly treatment-resistant, putting depressed people in remission at greater risk for relapse or recurrence. Additionally, insomnia in nondepressed people is a marker for depression later on.

Based on these findings, it would appear that people with depression-related insomnia or hypersomnia would derive more benefit from the sedative effects of trazodone than they would from treatment with Ambien. Nondepressed people might also derive more benefit from trazodone if insomnia is indeed a marker for depression in the future.

Common Side Effects of Trazodone

Trazodone can cause side effects for some people:

• Irritated eyes
• Tinnitus
• Sweating
• Drowsiness
• Libido changes or sexual dysfunction
• Tremors
• Poor coordination, dizziness, poor balance, and unsteady gait
• Neuropathy in feet, hands, legs or arms
• Muscle pain
• Dry mouth or metallic taste
• Confusion
• Bad dreams
• Anxiety and nervousness
• Skin rash
• Poor concentration
• Fatigue
• Headache
• Constipation or diarrhea
• Nausea and vomiting

Drugs That Interact With Trazodone

Check with your healthcare provider for drug interactions specific to your case.

• Monoamine oxidase inhibitors (MAOIs)
• Alcohol
• Barbiturates
• Any CNS depressant
• Ritonavir
• Ketoconazole
• Indinavir
• Itraconazole
• Carbamazepine
• Digoxin
• Phenytoin
• Serotonergic drugs
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Aspirin and other drugs affecting coagulation or bleeding like warfarin

All About Ambien (Zolpidem)

Ambien is a sleep aid pill. It’s a hypnotic drug, also known as a benzodiazepine receptor agonist, prescribed for people with chronic insomnia. Ambien was approved in the United States in 1992 under the brand name Ambien.

Generic alternatives became available in 2007. Because of its highly addictive nature, this medication is meant to be used only as a short-term treatment for insomnia and may cause withdrawal symptoms when stopped.

Zolpidem is a highly effective depressant of central nervous system activity and enhancer of GABA (gamma-aminobutyric acid) transmission. This means that Ambien works by increasing the concentration of GABA in the central nervous system.

For that reason, it’s a popular go-to prescription medication for physicians. Ambien also has the advantage of low rebound insomnia after it’s discontinued.

That being said, the drug is not without certain risks. Researchers have established that memory loss the day after using Ambien is common. People can lose all recollection of what happened after taking the drug.

When a person is under the influence of Ambien (even at low doses), they don’t necessarily head straight to bed, go to sleep, and stay that way all night. Instead, the drug can cause them to indulge in erratic and unpredictable behaviors. The nocturnal activities performed by Ambien users have been dubbed “complex sleep behaviors” (CSBs) by the scientists who study them.

People can get up to all sorts of potential mischief while performing CSBs in an altered state:

• Taking the dog for a walk
• Having a snack
• Going shopping
• Having sex
• Cooking a meal
• Driving to the grocery store for ice cream
• Having conversations
• Cleaning the house
• Rearranging the furniture

As if that were not enough, people on Ambien can seriously injure or even kill themselves in the course of their escapades. The FDA has confirmed at least 20 deaths and 46 serious injuries involving people who were under the influence of Ambien.

The serious injuries and deaths prompted the FDA to attach a black box warning to Ambien informing physicians about the sleepwalking risk associated with Ambien and other similar drugs. A black box warning is the most serious designation that a medicine can receive from the FDA.

A black box warning alerts prescribing physicians to a drug’s potentially serious or life-threatening side effects. It tells prescribers that a drug should be prescribed only in cases where the benefits clearly outweigh the risks.

Here is a breakdown of the number of injuries and casualties that occurred in people who were under the influence of Ambien:

• Falls accounted for 22 serious injuries and six known deaths.
• There were five suicide attempts and four suicides.
• Seven people injured themselves.
• Five people overdosed accidentally.
• Five people were injured by hypothermia.

What Causes Complex Sleep Behavior?

Classified as parasomnias, CSB can develop for various reasons. Although the activities involved may seem harmless enough, the likelihood of death or serious injury is a very real danger. This holds true whether the behavior is a medication side effect or due to something else.

A 2013 Taiwan study entitled “A comparison of complex sleep behaviors with two short-acting Z-hypnosedative drugs in nonpsychotic patients” examined the effects of CSBs that occur as a side effect of zolpidem (Ambien) and zopiclone, a similar drug.

People experiencing CSBs are not lucid. In many cases, they are unaware of their surroundings. For that reason, they can unknowingly hurt themselves and others. The authors of the study cautioned physicians to closely monitor patients receiving zolpidem for unusual activity during sleep time. Unfortunately, people who live alone may be unaware of these activities and therefore unable to report them.

Is Xanax the Same as Zolpidem?

No. Xanax (alprazolam) is a benzodiazepine drug that’s approved for anxiety disorders and panic attacks. It’s also prescribed off-label for insomnia.

Ambien (zolpidem) is a sedative/hypnotic controlled substance from a drug class called imidazopyridines. Ambien is approved to treat insomnia due to a medical condition on a short-term basis. Both medications can cause physical dependence if not used properly, such as in higher doses.

Is Ambien a Barbiturate?

No. Ambien (zolpidem) is not a barbiturate. Like Ambien, barbiturates are sedative-hypnotics, but they also have anticonvulsive properties. Barbiturates were used to treat insomnia before the development of Ambien and similar drugs, and they are still used today to treat convulsions.

Common Side Effects of Ambien

• Metallic taste or dry mouth
• Next-day sleepiness
• Dizziness and drowsiness
• Headache
• Nausea and vomiting
• Back pain
• Diarrhea

Serious Side Effects of Ambien

• Amnesia or memory impairment
• Falls, especially in older people
• Hallucinations
• Depression or sadness
• Delusional thinking
• Complex sleep behavior (CSB)

Drugs That Interact With Ambien

Check with your healthcare provider for drug interactions specific to your case.

• Pain medication
• Cold medicine
• Muscle relaxants
• Antidepressants
• Seizure medication
• Antianxiety drugs
• Alcohol
• Antipsychotics

Be aware that insomnia may return when Ambien is discontinued. The condition may seem worse as you experience withdrawal symptoms. Because this medication should not be used for more than a few weeks, it’s not a viable long-term solution.

In a 2019 paper entitled “Cognitive-behavioral therapy for insomnia: An effective and underutilized treatment for insomnia,” the authors had this to say about the treatment of chronic insomnia:

The most effective nonpharmacological treatment for chronic insomnia is cognitive-behavioral therapy for insomnia (CBT-i). CBT-i produces results that are equivalent to sleep medication, with no side effects, fewer episodes of relapse, and a tendency for sleep to continue to improve long past the end of treatment.”

Sleep is a wonder drug that can heal almost anything. During sleep, the heart, soul, body, mind, and spirit are renewed, repaired, and restored. CBT-i can help you activate your own natural sleep mechanisms without drugs. Call Live Free Recovery Services in New Hampshire. We can offer you medical advice to help you take your sleep back.

FAQ

References:

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077048/
• https://www.experiencerecovery.com/blog/what-is-xanax/
• https://primarycare.ementalhealth.ca/Canada/Trazodone/index.php?m=article&ID=20566
• https://www.baptisthealth.com/care-services/conditions-treatments/sleepwalking
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181883/
• https://www.medicalnewstoday.com/articles/hypersomnia-vs-narcolepsy#diagnosis
• https://my.clevelandclinic.org/health/treatments/23271-barbiturates
• https://www.clearvuehealth.com/b/ambien-complex-sleep-behaviors/
• https://pubmed.ncbi.nlm.nih.gov/35985088/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450729/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6796223/