Distressing Visual Hallucinations after Treatment with Trazodone

Area of Science:

• Pharmacology
• Neurology
• Psychiatry

Background:

• Trazodone is a second-generation atypical antidepressant.
• It is frequently prescribed off-label for insomnia treatment.
• While generally safe, trazodone can cause adverse effects.

Observation:

• A 60-year-old male patient was treated with trazodone for primary insomnia.
• Two days after starting trazodone, he presented with severe visual hallucinations.
• These hallucinations prompted hospitalization.

Findings:

• Trazodone discontinuation led to the complete resolution of visual hallucinations.
• The patient was subsequently treated with mirtazapine without relapse for two years.
• This case underscores a potential, though uncommon, side effect of trazodone.

Implications:

• Visual hallucinations can be a challenging presentation, especially in patients without a significant psychiatric history.
• Accurate patient history, including detailed medication review, is crucial for diagnosis.
• Clinicians should maintain awareness of trazodone's potential to induce visual hallucinations due to its widespread use.