Tramadol Plus an Antidepressant is Bad News…

by Chris Centeno, MD /

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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

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!

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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: https://regenexx.com/blog/what-you-need-to-know-before-signing-up-for-spinal-decompression/ and https://regenexx.com/blog/spinal-stenosis-surgery-alternatives-stem-cells-or-prp/ We can also often help with pain after neck fusion: https://regenexx.com/blog/pain-after-neck-fusion-2/

  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: https://regenexx.com/conditions-treated/hip/

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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