surgeons performing an operation

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.

Serotonin Syndrome

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.

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  1. Mariah
    Reply

    i took PAROXETENE from 2002 to 2017 and had to stop because i started taking Flecanide for my new AFIB diagnosis. i feel that i am still having withdrawal symptoms from Paroxetene. i used TRAMADOL for the first time a couple of months ago or three. wow. I never felt better. i felt like this took care of my back pain AND my need for meds such as paroxetene. i stopped tramadol because i was reminded it was a pain med and not a med for depression or anxiety that i seem to have.

    but a couple of days ago i started feeling like i was having a panic attack like as i slept i woke up feeling like i was choking and i was simply afraid. last night i gave in to tramadol…one pill, i took one pill and i felt normal again. i am suppose to take it every 6 hours for pain. but i have no specific pain so i gave it up because i do not want to have issues withdrawing from an opiade. One of my doctors want to prescribe Zoloft for me but cannot because of Flecanide. i am meeting with my electrophysiologist in a couple of days to see if there is another med i can take besides Flecanide so that i can start taking zoloft. my friend tells me zoloft is not safe either. i am going to start again on the Tumeric that my chiropractor suggested i take. in this section, i read Tumeric is indeed a good other to take. i am 75.

  2. PapillionNE
    New Mexico
    Reply

    This chain of notes from you all has helped me a lot. We are all so unique, and when you find something out about your metabolic processing with these medications, write it down in a journal so you can let your prescribing physicians know, as well as your pharmacist (Use One Pharmacy, and know your pharmacist). Be sure to tell any doctor and anesthesiologist when you have any surgical procedure about all medications you are using because during the procedure, you can stop breathing. The recommendation about tumeric is great, add ginger for even more benefit. Contact ProCaps Labs…it’s a great supplement provider (hsn.com)..they have sales many times in the year..all with free S/H. About the combination of an SSRI and tramadol, this is a dangerous mix. Know what Serotonin Syndrome is, for sure. Know the symptoms. It can be very dangerous. I had a horrible reaction when a doctor prescribed Zoloft, also Cymbalta, for my fibrobyalgia pain, anxiety and insomnia, and the combination left me paralyzed and able to only move my eye balls, for an hour. (and,, SSRI’s MAKE a person depressed). With seratonin syndrome, thought I was going to die, or break bones, as I kept trying to get up, and my arms and legs would not support me. It took some time to let my husband know in the other end of the house, that I was having a problem, as I couldn’t even yell. And I wasn’t even combining the Zoloft with tramadol. As I said, every person responds in a unique way, so just be educated for the “List of Watch-Out Symptoms” of possible drug interactions or allergic reactions to medications, and combinations of prescription medications. No alcohol on any of these drugs, no Nyquil, no cold medications, nothing that will interfere with your consciousness or breathing. What to watch out for: breathing slowness. high BP, unable to regulate body temperature, tingling in limbs, face, tongue, also a “swollen” feeling, also a cotton mouth, headaches, insomnia, mood swings/agitation/euphoric (that combination sounds bi-polar, yes, these controlled substances actually cause bi-polar disorder), concentration diminished, also muscle and appetite changes. Horrible constipation. Some muscle loss can be permanent. Do not use zolpidem or valium with tramadol. Get rid of it.

    Okay, here’s the fact: Prescription medication can get us all into nursing homes too early in our lives, or, will leave us disabled as adults, or in the grave. That isn’t what we want. I think a lot of this medication is addictive, and does permanent damage physically, emotionally, and mentally. I have lost several family members go prescription medication, causing them lung issues, dementia at 60 y.o. and impaired judgment, as well as agitation to the point of losing friends)I am going to focus now, in my sunset years, on my health and well-being, call on shut-ins, and memorize Scripture and pray to my Lord. My mom and my precious son were/are alcoholics and addiction ruins lives. Take care of your bodies as much as you can, naturally. I know what I’m talking about. I only sleep once every 4-5 days, because of pain. I was 56 when we adopted our precious foster baby, and I want to see him graduate from high school. He is just going into 6th grade. I know I won’t if I use prescription medication for these disorders. I have osteoporosis and that hurts too, Everything hurts, and family members sometimes can hurt me even more with their unhelpful comments that it is “all in your head.” Thanks. When pain comes, let it be a trigger to look up, and thank God for these years. ” To live is Christ, to die is gain.”

    Please consider this very carefully. You can get support in so many places. Shed the shame, and get a plan to get off of tramadol, or valium, clonapan, and the lot and find other ways to handle pain. Our quality of life is put in the hands of the phamaceutical companies (I know, I worked for a large pharmaceutical when I went to Grad school), and the ignorant doctors (who love the pretty young pharmaceutical reps who push these products to all prescribing physicians, these reps who have deep pockets in their “marketing budget” for entertaining these doctors, and these reps are also at work in the medical schools, selling doctors early on, in this co-dependent relationship between doctors and pharmaceutical companies) Put your quality of life in the One who created your unique and amazing body. At age 70 I’m checking out of the medical community. This idea was given to me on an airplane, and he happened to be sitting next to me. He looked at what I was reading (a medical journal) and so we talked, and this was his plan – to just stop. Just buried my two best friends in the world, very elderly, but 15 years being kept alive with prescriptions, so many, both fine ladies with congestive heart failure, other issues of course (kidneys, colon, IBS, FMS, diabetes), and I think I’ll just take my Synthroid in the morning and use my supplements, one of which completely took away my arthritis (Arthro-7). NEVER stop taking your prescriptions without talking with the prescribing physician as this can do harm. Each medication has a weaning plan that you can apply to your unique body. After 70, I also won’t have any more mammograms (we call it the pancake boob maker), including mammography, nor any CT scans, which are 40x the radiation of an x-ray.

    In the end, you will do what you think or know to be best for you. We aren’t alive to live on this planet forever, and think of how many people you know OVER 80 who just pass away quietly in their sleep, who had never been in an hospital, no prescriptions in their lifetime, no hospitalizations. The government and health care industry want us to believe we are all able to live quality lives until 100 y.o. Well, it is a lie. While the human body is unimaginably miraculous in its design and functionality, love capacity, athletes constantly breaking records, little ones surviving cancer when caught early, there is the issue of this: birth and life are a 1:1 ratio. Always has been, always will be. That is the plan, because the One who made you wants you out of this messy world and reconciled to the original perfection through His Son. There are many who come to know Him on their death beds. I am not afraid of that,nor of pain. I’ve lived with it too long. I won’t die of pain. However, I could die from prescriptions, or worse, be in a nursing home, or yet worse, depend on my husband to serve me. Youza, have you met my husband?

  3. Dave
    Ohio
    Reply

    I’ve taken tramadol for approx 20 years, it works incredibly well with my physiology. It literally numbs the notification of pain in many forms, also reduces the feeling of cold, hot, as well as normal symptoms of lower back pain, muscle pain, joint pain. Im not sure if it works on migraines , as i don’t suffer from them. there is an energizing effect from morning dose. I use very little (50mg) and it works well. I have read stories of abuse where people have used as high as 1000 mg in a day. I seriously cannot imagine this as there is a cap of its effectiveness regardless. it does not work the same as other opiates like oxycodone and hydrocodone. It doesn’t slow me down or provoke a opiode high.
    when using this small 50mg dose and a 20mg fluoxidine dose, there has not been any indicators of seizures or other side effects. I can only speak from my experience. i still must be resonsible and suggest you do follow your doctors advice.

  4. Connie
    Arkansas
    Reply

    I would not mix this medication with antidepressants unless the doctor okays it and then be cautious because it does interact with many things because of the neurotransmitters it affects. I personally have not gotten past two pills due to side effects BEFORE I started antidepressants. It kept me awake but made me weary tired and I consider it a nasty drug. Now if I try it , I itch allover worse than a stronger antibiotic. Craziness.

    • abbey
      Reply

      I have the same thing happen to me when I take Tramadol. It makes me unable to sleep, but tired, also sweaty and insanely itchy. I feel like a drunk person with ants in my skin

  5. Alias
    Durban, South Africa
    Reply

    I have twice experienced horrid side effects from taking Stilnox and Ultracet together. They have included profuse (cold) sweats, disorientation, lack of physical co-ordination and impaired judgement. I suspect that there was also an associated dramatic drop in blood sugar (resulting in the cold sweats). It’s a combination I will never use again.

  6. Debbie
    burlington
    Reply

    Then what can you take?? I need surgery and am on generic lexapro and will only stay one night in hospital. It is surgery for my spine c3-c7 that are compressing my spinal cord severely. I will have to take Flexaril, Oxycodone, Prednisone and my usual Toprol xl 25 mg. plus other meds. What can you take? I will be in a lot of pain and have spasms and swelling also.

    • Melissa
      WI
      Reply

      Debbie- I had a hysterectomy and laproscopic surgeries and found, though I metabolize morphine quickly, this was the best pain medicine with the least amount of side effects. About 2 yrs ago, I had a genetic swab test test done to identify how my body metabolizes all meds and it was the best thing I could have done. Most Ins Co’s cover it. I did so, because I have had horrible side effects on pain meds and even OTC sinus meds. There are a lot of Dr.’s and pharmacies that will prescribe these meds to you so unfortunately you have to do your own research. With me, I can’t take any ‘hydro’ or synthetic pain meds because of the adverse reactions. Also, please note that if you take any Benzo’s for anxiety, do not take them while taking pain meds. Lastly, pain meds are horrible in their own right but try to have them give you enough for just a few days and ween off and switch to ibuprofen or acetemetephine. Take a cleansing routine with milk thistle or apple cider vinegar to help cleanse your liver. In addition, if you are suffering from spinal/back issues try natural anti-inflammatories like tumeric. Being on pain meds can hinder your healing more so because you will think you have the mobility that you actually do not and because you are ‘numbed’ you can run the chance of using your body in ways that can really hurt you.
      I wish you the best!

  7. Tracy mace
    Canterbury
    Reply

    I have been taking Tramodol and Sertraline together for 9 years with no adverse effects. I have asked several gp’s and my neurologist if this combination is ok and they all say yes. But 3 years ago I started having Epileptic Seizures. I am taking Lamotrigine as well now.
    I also have secondary Multiple Sclerosis and that’s the reason I was put on Tramodol. To help with my ms symptoms. Like the horrid burning sensations I have when seated and in all my limbs. The Tramodol certainly helps with this but with all the drugs l’m on this causes constant constipation so I am constantly taking Dulcolax.
    I am concerned about all the drugs I’ve been taking for so long and my liver, but all the health professionals say this combination is ok.
    I would be interested about what others think about this.

    • Anon
      UK
      Reply

      ‘No adverse effects’ … ‘3 years ago I started having Epileptic Seizures’ … not so sure about that. I think seizures are a common symptom of combining Sertraline and Tramadol.

  8. S. Dolan
    Missouri
    Reply

    Maybe the adverse reaction was dose-related; maybe the anesthesia had a part.

    I take and SSRI as well as tramadol under a doctor’s supervision, and have no adverse effects. Had surgery two years ago while on the same medication and no adverse effects.

    Although it’s a pain to list all my meds and otc supplements, it’s for the patient’s safety, and I give a list to any Dr. treating me. Once you do it – on Excel, Word, whatever, it’s easy to update and print out. I also include drug allergies, past surgeries, and past adverse reactions.

    • Helen M
      Modesto, CA
      Reply

      Do your doctors actually look at your list of supplements and input it into their records. Do they search for adverse combinations? I have never had a doctor interested in my supplements and my oncologist told me, frankly, that he knew nothing about supplements. Which, to my mind, means he knows nothing about functional medicine. So, other than certain tests, why bother to see an ignorant doctor? With the other doctors, I may have certain hopes for better health, as well as needing those prescriptions, so I go.

  9. Charlotte
    Plano, TX
    Reply

    Read your letter regarding Tramadol interaction with an SSRI. My husband took tramadol after a lithotripsy procedure to break up a kidney stone. He was on sertraline 25 mg. along with other drugs to treat his Alzheimers disease. After just one dose he became so agitated including extreme paranoia and terrifying hallucinations that after calling the doctor, upon their advise, I took him to the emergency room. It took both my son and I along with a tech to control him from ripping out tubes, etc., and leaving. It took three injections of both Valium and some other sedative that we were told would put him out within 10-15 minutes. His eyes never closed. We finally brought him home where the nightmare began of his getting out of bed and falling numerous times. Was told that he was allergic to the tramadol. They never, the prescribing physician nor the hospital staff, connected the dots between the sertraline and tramadol.

    • Jack Wood
      US
      Reply

      So I have severe arthritis and suffer from clinical depression. Must I decide between tramadol or zoloft — choose pain or depression? Tell me a combination that works instead of reasons to stop taking something that works for me and has caused no problems.

      • Melissa Redmond
        WI
        Reply

        Jack- Please, look into using Tumeric. Stay on the Zoloft. Any natural anti-inflammatories will help with depression and more over joint pain and arthritis. There is tremendous amounts of medical journals and studies that support these findings. My mom uses tumeric & she works a very physically demanding job at 67 yrs old and she can run circles around the 20-somethings that she works with.

      • Bernardo
        Europe
        Reply

        Tramadol is the best antidepressant I have tried (it works as an instant Serotonin–norepinephrine reuptake inhibitor (SNRI). If I where you I would just use Tramadol for both the depression and pain management (2 in 1).

        Only problem is that Tramadol can be hard to quit, you get sick with fever for a few days, (it is an opiod), also if it makes you feel good as in not being depressed, you probably don’t want to quit…

        But try quitting a strong antidepressant like Effexor, you can have side effects like hot-flashes, tremors and such for up to 18 months after…

        All these commercially available SSRIs, NRIs, SSRIs (antidepressants) also have horrible withdrawal symptoms, and they are physically addictive.

        I believe only reason they (SSRIs etc) are considered non-addictive is because most people don’t like them and want to get off them because they are just not very good “pharms” to begin with, and there are just so many side-effects it is crazy…

        Good luck and happy healing!

    • Ella
      East Coast
      Reply

      I doubt it was the combination of SSRI w/ Tramadol from one dose. I am a retired Recovery Room nurse. When a patient has a type of dementia or just elderly, they can have extreme reactions to one dose of medication, after a procedure. I have seen it happen esp w/ nausea med & pain med.

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