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Tramadol (Ultram) alternatives

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Posted 3/18/2011 2:22 AM (GMT 0)
Hi,

I usually post in the Chronic Pain forum but have a question more suited to this one.

I suffer from pain due to an accident in 2004 that decimated my hip and sacroiliac; and I also have scoliosis in my upper back whose pain has grown to be worse than the hip/SI pain.

Anyhow, I've suffered from depression through most of my adult life but from 2007, when I was first prescribed tramadol for pain, until recently, I've had a great hiatus from it.

I take 300mg of Ultram ER daily but have built up a tolerance. It no longer is helping my depression and as the degeneration due to my scoliosis has worsened, I need a stronger time-release medication. So, when I next see my pain management doctor, I will address stopping Ultram and switching to a different time-release opioid.

I use other opoids for pain and none have had the effect on my mood that tramadol has. I want to be clear -- it is not that it makes me "high". But rather than living in a gloom of despair, suicidal ideation, etc., I've felt normal. I've not had to struggle to get out of bed, have been interested in doing things, in new projects, able to concentrate on work, etc.

Tramadol is prescribed off-label for depression, and has been recognized to have, among other effects, SNRI properties and functions as well as a serotonin releasing agent.

So, I'm wondering what to switch to? I expect my pain doctor will move me to oxycontin or time-release morphine for pain. But I would like to find a replacement for the anti-depressant effects of tramadol.

Has anyone here found tramadol helpful for depression, built up a tolerance and then found something else also effective?
Posted 3/18/2011 4:09 AM (GMT 0)
Hello, Cogito,

You're taking a Selective norepinephrine reuptake inhibitor, I
believe, if I read your medications correctly. Have you discussed
taking higher levels of Tramadol for relief? Most of us on this forum
are familiar with the Selective Serotonin Reuptake Inhibitors, but I've
never spoken to anyone on the forum who is using a norepinephrine
reuptake inhibitor. The drugs which are derived from the adrenal
glands or sympathetic or autonomic nervous system require expert
advice from your selected physicians. I rather doubt, as well, that anyone on our forum has had such extensive opiod use.

Frankly, the use of heroin derivatives is outside the realm of most
of us and especially for daily use. Perhaps we've experienced use
of morphine for surgery; otherwise, not many here would understand
the use of narcotics.

I can sympathize with you greatly and hope you will discuss what's
best for you to do both with your psychiatrist and nephrologist and
even your cardiologist, since you also have tachycardia, as well. The
adrenal gland reactions may be something a nephrologist might be
able to help you mitigate, which in turn, might mitigate the tachycardia.

You have a set of complex problems that you need to work with experts to assist you. I'm sure the pain must be severe, and, hopefully, there will be newer medications that you may use that will alleviate your suffering. Only the best experts will be able to advise you correctly.

I'm very sorry that I am not knowledgeable enough about your disabilities to be of help, but I do wish you to be encouraged by what's new in the medical field for relief of severe pain and accompanying depression--perhaps caused by the physical illnesses.

I would be interested to know, however, what answers you find from
your physicians as to what route you should probably take to get the
relief you seek.

Good wishes,

It's Genetic
Posted 3/18/2011 4:35 AM (GMT 0)
Thanks for your concerns. I did talk to my doctor during my last visit about moving up to 400mg. However, there is a risk of serotonin syndrome and so he doesn't prescribe above 300mg.

I understand that most members of this forum are unfamiliar with opioids. But I'm not looking for one to substitute for the anti-depressive effects of tramadol.

The anti-depressant that is molecularly closest to tramadol is effexor according to wikipedia. Cymbalta is also a commonly prescribed SNRI.

So, I'm curious to see if there's anyone who found tramadol beneficial, then developed a tolerance and moved on to a standard SNRI or something more arcane such as a serotonin releasing agent or a 5-HT2C antagonist.
Posted 3/18/2011 1:45 PM (GMT 0)
Hello, Cogito,

I've seen several people post on the bipolar forum regarding use
of Effexor or Cymbalta; you might try your request there.

The Serotonin syndrome is quite rare, actually, and is associated with
the use of 5htp Tryptophan while using an SSRI. (It is easily obliterated by stopping use of the SSRIs overnight-or for 24 hours.) If
the syndrome lasts longer, there are other medications that will clear up the illness. It is important, however, to get immediate medical help if the illness appears.

Hopefully, you will find someone more aware of the two similar molecular makeups of Effexor and Cymbalta to the medication you
are taking.

Good wishes,

It's Genetic
Posted 5/24/2011 6:31 AM (GMT 0)
Hello It's Genetic,

I was diagnosed significant ADHD in 2009 [-8.44, with "significance" beginning at -1.80], as well as depressed with anxiety disorder, and have tried several meds for both my ADHD as well as my depression [Ritalin-BAD; Adderall-GREAT weight loss pill!; Wellbutrin-WORTHLESS (for me); Effexor-Jury is still out; Zoloft-Turned me into a "love" star!!], and I must say...so far...Tramadol has been BY FAR the most effective drug I've taken for anxiety and depression, as well controlling my impulsivity associated with my ADHD, and I stumbled upon it by accident, due to severe back pain!!

I, too, was [and have, at times resumed taking] Tramadol for anxiety and depression as it works FANTASTIC for me, even at relatively low dosage. I had gotten to 200 mg a day, along with Zoloft in the afternoon, and I think it was the Ultram that was doing me the most good. HOWEVER, I ran out one day and went about 36 hours without it, and had the MOST HORRIBLE discontinuance syndrome!!! I weaned myself from it, gradually, over a 10-day period, but it was HARD! Imagine restless leg syndrome over your entire body and wanting to throw yourself from a building just to escape the sensation of ants crawling through your veins! I am EXTREMELY sensitive to meds [i.e. 2.5 mg of Amitriptyline (sp) can make me sleep all night!], and life was a LIVING HELL stopping Tramadol!!!

What I am wondering is this: is there any drug that IS NOT as likely to produce the physical dependence that Tramadol does (for me), but relieves the anxiety/depression/impulsivity? I can't emphasize enough that when I take ONE 100 mg Tramadol, for about 6-8 hours, I feel perfectly even keel, in control, and have ZERO anxiety, or the tell-tale intolerance of little inconveniences that (tends to go with) my ADHD!

Any thoughts?

Fireboy
Posted 5/24/2011 10:52 AM (GMT 0)
Hi Fireboy,

Welcome to the forum. And hello to Cogito too.

I had no luck with tramadol. It didn't help with the pain and didn't make me feel any better. But all of us are different. I take pristiq and abilify and do well on that.

Do know Cogito, that opiods do cause depression, so you might need something to combat that if the situation arises. They do depress the nervous system which also leads to mental depression. I hope that you get the oxycontin rather than the morphine, becauwse morphine can make you very sleepy and you can nod off while driving or something. Oxy kind of makes you feel nrrmal. Though I take norco. It is a low dose type of narcotic. It works well for my pain.

I hope that you both find what works for you. You have gotten some very good advice by It's Genetic. She is a smart lady.

Keep posting, know that we care.

Hugs, Karen
Posted 5/24/2011 5:27 PM (GMT 0)

 WOW COGITO,

I usually post in the Chronic Pain Forum as well, but came here since the lack of pain control is really kicking my depression up several notches, and I thought I might try a different perpective.  We have very similar back problems, although my doctors barely let me keep the lowest of hydrocodone prescriptions(#30 5/500s every 10 days) along with some Ultram.  You are lucky that you actually are prescribed stronger medication, even if you have developed a tolerance.  I have as well, but there's no change in Hades that my pain meds will be strengthed or increased. 

I hit the wall last week as my shrink went out of town and it took a WEEK to get my depression/anxiety meds refilled by the fill-in doctor.  Not a good situation.  I'm on Disability, and half of my psych meds and my migraine meds aren't even covered by my prescription plan.  The cost is astronomical, so I'm having to depend on getting samples when I can get them, or trying to get them from the drug manufacturers once I hit the "donut hole" in my coverage.

What I take that usually does a pretty good job of handling the depression is a new medication called SYMBYAX, along with some Klonopin for anxiety.  That might be a combination you might look into trying. My having gone without them pretty much cold turkey for a week has really fouled me up, and never should have happened. 

Basically, I'm sick and tired of being of being sick and tired.  My migraines are brought on by changes in weather, and here in Central Virginia, the weather is like a dern yo-yo, constantly back and forth.  I'm a 46 year old divorced female, and frankly, I'm tired of living alone with three cats.  I've been making the effort to get out there and make the social rounds, but I swear, people in this neck of the woods have never matured past high school.  I try to keep busy with activities, but I feel like I'm just spinning my wheels.  I have plenty of "friends", but none that actually involve me in their daily lives or keep in close contact with me.  Heck, I live maybe a mile away from my parents, and they don't even bother to make sure I'm still breathing on a daily basis.  The prospect of things just continuing to degenerate over time and having to deal with it all alone is almost more than I can bear.

Leigh Ann scool

Posted 4/22/2012 3:05 AM (GMT 0)

Howdy, folks. This may be a first for this thread, but I am writing you from inside the major regional neuropsychiatric hospital I was checked into a few days ago for opiate abuse - specifically, self-medicating with tramadol the last 3-4 years so I could live a relatively normal and productive life without wanting to jump in front of every passing bus. Here are some facts I can share with some confidence. First, notwithstanding the good fortune of having access to top notch psychiatric care, and all of the wonder drugs available to those of us with some resources to treat those of us identified as severe bi-polar 2 victims, tramadol is the first and only thing that ever worked for me. And by "worked," what I mean is that it enabled me to live a normal family life, supporting my wife and kids as an upper middle class professional person, finding some reasonable enjoyment in life again, etc., etc. Second, tramadol is addictave. But I'd rather live addicted to tramadol than be roadkill under a bus or train because I cuoldn't stand to see the sign rise one more time. Third, there is only so long you can medicate yourself successfully - with tramadol, or probably anything else. I was lucky I didni't kill myself or someone else by having a seizure on the highway. Fourth, there appear to be some smart and forward thinking people looking at starting to use things like suboxone to help people like me live decent lives. That's where my treatment team at the neuropsych hospital is headed at this point. I'll try to to check in from time to time to let you all know how that's working out. But I am optimistic. And the thought of not having to hide my tramadol use from my wife anymore is a helluva bonus. Best of luck to all of you. I truly believe there is hope.

Posted 4/22/2012 10:35 AM (GMT 0)
Hi Todo,

Welcome to the forum.

Hugs,
Karen
Posted 4/22/2012 12:18 PM (GMT 0)
Hey Cogito

Welcome to our world. I lurk around chronic pain forum. There are alot of us who suffer chronic pain and depresssion.

Tramadol never had that effect on me-wish it had. I have found that my daily hydros so give me a sense of normalcy,  not a "high" but just ability and willingness to get out of bed and be a human being. BUT!!! This is a double edged sword because of tolerance, dependence yadda yadda. I have also been on anti depressants for 7 years. The only things that helped me were the SNRIs, which are way more prevalent than alot of people think. SNRIs include Welbutrin (which I took successfully for 5 years) Effexor, Cymbalta. And abilify I think.

Karen is right, narcotics are depressants, altho alot of have what is called an oppositional or paradoxical reaction to them. The use of narcotics to treat depression sould be a huge ethical no no in medicine.

I would hope that your doc will NOT start you on oxy or morphine, but hydrocodone, if something else is not availaable. Perhaps these in conjunction with an SNRI would be a good combo.

I stopped welbutrin when it suddenly stopped working and have recently started effexor xr. Alot of friends have reported success with this drug-

Please let us know how it goes

Maggie

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