Q. Recently my husband took tramadol after back surgery. He was also taking an SSRI anti-depressant.
He suffered severe hallucinations and sleep-talking throughout the night. The ER doctor suspected serotonin toxicity from the combination of tramadol and the SSRI. It took almost a week for him to get back to normal without tramadol.
A. Because tramadol is considered a pain medication and not an antidepressant, doctors sometimes don’t think of it as interacting with serotonin-based antidepressants such as citalopram or fluoxetine to cause serotonin syndrome, although it can do so (American Journal of Case Reports, Dec. 19, 2014). Several case reports of such interactions have been published.
Symptoms of serotonin syndrome include agitation, confusion, high blood pressure, rapid heart rate, muscle twitching, shivering, headache and diarrhea. Severe cases can result in high fever, unconsciousness or even death.