Dear Doctor: I am having a moderate depression. I am taking Zoloft 50 mg and Restoril 30 mg with Sustiva at night. I am not resting enough because I awake after 5 hours of sleeping. What do you think about taking Desyrel (Trazodone) instead of Zoloft? What about the sexual effects? With Zoloft I only had problems the first month.

Trazodone is an excellent sleep medication and is often used along with drugs like Zoloft to assist in sleep. Trazodone is no longer used much by itself as an antidepressant because of the high doses required for an antidepressant effect and the better alternatives available.

I have treated many HIV patients with combinations like trazodone and Zoloft. There is a risk of sexual side effects with trazodone, but the risk is low at the low doses used for treating insomnia. The most troubling side effect in men is priapism (painful, long lasting erections, in some cases requiring emergency and/or surgical treatment), but the risk of this adverse reaction is low.