Tramadol Plus an Antidepressant is Bad News…

By /

tramadol plus an antidepressant

A very common medication combo prescribed to patients with chronic pain is tramadol (Ultram) plus an antidepressant.  However, new research may call into question whether this is a good idea. Let’s dig in.

Depression and Pain

One of the biggest chicken and egg controversies that has been zinging around in chronic pain treatment circles for decades is whether pain causes depression or depression causes pain. I’ve always been mostly in the former camp, but many physicians are in the latter.

Because of this association patients in pain are often prescribed antidepressants. In addition, when they still have pain, a common pain killer that’s prescribed is Tramadol. What’s that?


Tramadol is also called Ultram here in the U.S. and ConZip elsewhere. While many patients don’t know this, it’s actually an opioid that acts at a different pain receptor than traditional narcotics. It’s also a prodrug.

Some types of narcotic analgesics, called prodrug opioids, rely on a particular liver enzyme (CYP2D6) to convert them into a form the body can use to target pain. It was already known, from a study published earlier this year, that SSRIs like those mentioned above, decrease the pain–relieving abilities of these prodrug analgesics.

More recently, researchers looked at the records of patients who were either admitted for observation or were hospitalized as inpatients for pain control. The patients reviewed had been given tramadol for a minimum of 24 hours. The study showed that patients who were also taking SSRIs needed up to four times the amount of tramadol to control their “breakthrough” pain than those who were not taking the antidepressants.

What’s the Answer?

Many people who suffer from chronic pain are depressed and take medications. Many people who have chronic pain also take pain medications. So what’s the answer?

The answer is to figure out what’s causing the pain and treat it without surgery using interventional orthopedics. To start on that journey, read my book, orthopedics 2.0:

The upshot? Be cautious about taking Tramadol with an antidepressant drug. In the meantime, your best move is to make sure that you figure out what’s causing the pain and get it treated without surgery!

Get health and wellness information from a trusted source.

By submitting the form, you are agreeing that you read and consent to our Privacy Policy. We may also contact you via email, phone, and other electronic means to communicate information about our products and services. We do not sell, or share your information to third party vendors.

Category: Uncategorized

Leave a Reply

Your email address will not be published. Required fields are marked *

4 thoughts on “Tramadol Plus an Antidepressant is Bad News…

  1. debra

    Unfortunately, all of our orthopedic problems do not respond to stem cells/orthobioglogics. I wish they did it would have saved me from 3 failed cervical spine fusions for cord compression.

    1. Regenexx Team

      Hi Debra,
      Very sorry to hear that. Depending on the cause, intervening first with interventional orthopedic orthobilogoc procedures can often help. Please see: and We can also often help with pain after neck fusion:

  2. Preston Dula

    Considering stem cell injection vs. Hip replacement, ive postponed by use of tramadol in order to continue working to this point

    1. Regenexx Team

      Hi Preston,
      If you’re considering stem cell treatment a Candidacy review asap would be important, as unlike knee arthritis, hip arthritis escalates very quickly. To do that, please submit the Candidate form here:

Is Regenexx Right For You?

Request a free Regenexx Info Packet


Learn about the #1 Stem Cell & Platelet Procedures for treating arthritis, common joint injuries & spine pain.

Join a Webinar


Get fresh updates and insights from Regenexx delivered straight to your inbox.

Subscribe to the Blog


9035 Wadsworth Pkwy #1000
Westminster, CO 80021


Copyright © Regenexx 2020. All rights reserved. | Privacy Policy

*DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.

Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.