Expert: Ivan Goldberg, M.D. - 11/9/2006

Question
Hello Dr. For years  have struggled.  am 41. I have been on several medications for the past 20 years.
When I was diagnosed with depression early on I was given an an anti depresant Did not help. My kids were small and I was miserable and I kept going to the Dr. saying something is not right........For years I was treated with depression. On and off and the meds made me worse. I started taking redux to loose weight and suddenly my moods were better and I had energy. After it was pulled off the market I went to the Dr, to find something to replace the "normal" feelings.. I was so frustrated because I wasent being heard, But I did learn that The redux boosts seratonin.. Ah ha.... Still Drs, insisted on so so many pills..Effexor, Depakote, seraquil,abilify paxil..it goes on.. I would go so frustrated and stop taking the meds that left me bedridden and depressed and self medicate with alcahol. I acted as a stimulant. I am a professional Artist and the meds left me lifeless and depressed.
I was then diagnosed with Bipolar and was hospitalized after taking the anti's I was suicidal. I had no hope or will. This is ongoing for the 20 or so years.. back on more pills...more and more pills leaving me lifeless. And then found out I was schitsoephective.. Every Dr. telling me something different....
Long story short. I have been taking Tramadol for about a year now and have NEVER felt better.. I have energy..great moods, I go to sleep at 11 as aposed to 3 am..
I get up and start my day full of energy.
I lost 2 dress sizes and am totally motivated to create and produce works for my business.
I am not lethargic anymore and have the energy to attend social functions as well as events with my kids. I have clarity, my sense of humor and a strong business sense while taking This...... I have been doing reasearch and have learned that although it is said to work in some people with depression it is not approved.
I have had to purchase Tramadol over the internet and I HAVE health Ins. How to I take thins information to my Dr.
What is your take on this? I would like Tramadol to be perscribed so I no longer have to pay out of pocket.
IT WORKS! I have none of the side effects listed for the use of this drug..... What is your Take? Very much appreciated.
Heather

Answer
Hi, Heather . . .

The following is form a book I am in the process of finishing:

Tramadol (Ultram)


Q: Is tramadol (Ultram) useful as an antidepressant?

A: Tramadol (Ultram) is an analgesic that relieves the symptoms of depression in some people who conventional antidepressants did not help. Although not classified as a narcotic, tramadol binds to opiate receptors in the brain. Like many antidepressants, it also affects norepinephrine and serotonin metabolism in the brain. Similar to other strong analgesics, it is possible to become dependent on tramadol. When patients rapidly stop tramadol a withdrawal syndrome develops, similar to that seen when individuals abruptly stop taking narcotics. When taken with other antidepressants, tramadol can cause serious side effects, including seizures, the serotonin syndrome, and even death.

Refs: McDiarmid T, Mackler L, Schneider D. What is the addiction risk associated with tramadol? Journal of Family Practice, 2005, 54, 72-73. Houlihan DJ. Serotonin syndrome resulting from coadministration of tramadol, venlafaxine, and mirtazapine. Annals of Pharmacotherapy, 2004, 38, 411-413. Mahlberg R, Kunz D, Sasse J, Kirchheiner J. Serotonin syndrome with tramadol and citalopram. American Journal of Psychiatry, 2004, 161, 1129. Skipper GE, Fletcher C, Rocha-Judd R, et al. Tramadol abuse and dependence among physicians. Journal of the American Medical Association, 2004, 292, 1818-1919. Soyka M, Backmund M, Hasemann S. Tramadol use and dependence in chronic noncancer pain patients. Pharmacopsychiatry, 2004, 37, 191-192. Gonzalez-Pinto A, Imaz H, De Heredia JL, et al. Mania and tramadol-fluoxetine combination. American Journal of Psychiatry, 2001, 158, 964-965. Shapira NA, Verduin ML, DeGraw JD. Treatment of refractory major depression with tramadol monotherapy. Journal of Clinical Psychiatry, 2001, 62, 205-206. Gardner JS, Blough D, Drinkard CR, et al. Tramadol and seizures: a surveillance study in a managed care population. Pharmacotherapy, 2000, 20, 1423-1431. Reus VI, Rawitscher L. Possible interaction of tramadol and antidepressants. American Journal of Psychiatry, 2000, 157, 839. Ripple MG, Pestaner JP, Levine BS, et al. Lethal combination of tramadol and multiple drugs affecting serotonin. American Journal of Forensic Medicine and Pathology, 2000, 21, 370-374. Spencer C. The efficacy of intramuscular tramadol as a rapid-onset antidepressant. Australian and New Zealand Journal of Psychiatry, 2000, 34, 1032-1033. Jick H, Derby LE, Vasilakis C, et al. The risk of seizures associated with tramadol. Pharmacotherapy, 1998, 18, 607-611.