I can speak as an habitual tramadol user, and certainly tramadol-dependent individual. My usual dose ranges from 300 mg to 500 mg/day, usually taking 400 mg/day. I don't take any typical anti-depressants, but have been using fairly modest to somewhat moderate doses of pharmaceutical amphetamine, with the tramadol, or on other days I'll use moderate doses of methylphenidate, with the tramadol, too. Though, I've never combined any really significant dose of amphetamine with methylphenidate, or vice-versa. However, I've never taken tramadol without a benzodiazepine in my system, for I have known benzo dependence for the longest of all. I take 4 mg clonazepam daily, divided into two daily doses, and even though I am very dependent, I feel that the benzodiazepine still exerts a certain effect of protective anti-convulsant action. Not to get into too much detail, but I also take a regular 4 mg lorazepam at bedtime, 200 mg pregabalin at bedtime, and 700 mg carisoprodol at bedtime - that cocktail is usually left at those doses, though I'll use additional benzo's, carisoprodol, and/or butalbital as needed, or as desired. Anyhow, the daily dose of tramadol at 400 mg/day has been part of my 'drug profile' for longer than anything but a 24-7 benzodiazepine, which has been the 4 mg clonazepam/day for a while now. I do feel, like I said, somewhat protected from the possible epileptic activity that tramadol can cause on account of always having been on a sizeable dose of a benzo taken 24-7.
I think tramadol has wonderful potential as an anti-depressant, and should be incorporated into psychiatry where appropriate, however it has its risks. I'd like to say I know of all of them, but I don't. I know that there are risks related to serotonin syndrome and seizure activity, but honestly I don't know how else the tramadol may be adversely effecting my health, and I suspect, in the long run, it will, at the very least, cause significant problems upon any discontinuation, where I'd bet that there may be certain persistent symptoms of depression and/or melancholia even after the acute withdrawal phase, at least for me. This is frightening, and luckily I am not considering discontinuing it in the near, or even intermediate, future, so I needn't worry about that right now. I do have a feeling that the longer I continue to let the dependence continue, the more profound the lasting effects of the tramadol will be upon eventual discontinuation. I am sort of rambling, here, so I am sorry if I am not helping, but I am sharing my experience with the substance, so it is something. With the tramadol, I usually dose 200 mg when I wake, 100 mg anywhere from three to six hours after that, and 100 mg as my last dose of the day. Frankly, I could not imagine stopping cold turkey with tramadol, on account of the few tastes I had with which what would, now, be very mild withdrawal for me, considering only after six or eight weeks of daily use, I experienced relatively strong withdrawal symptoms, but that was a few years ago, and now I have been taking tramadol daily for a few years, with one hellacious exception of very brief abstinence from the drug, which was over with after about 48 hours of not having the tramadol. The frightening thing, for me, with the idea of tramadol wd's, too, is that it acts in more than one simple way with respect to its pharmacological effects - a serotonin releasing agent, a norepinephrine reuptake inhibitor, and, especially on account of its active metabolite, o-desmethyltramadol, the opioid agonist effect, along with other effects it exerts via its mechanism of action. With my fatigue, and fibromyalgia symptoms, this becomes even scarier, for me.
No doubt, I have felt, and do feel, certain adverse effects from the tramadol's effects, though most are transient as of now - hot flashes and a propensity to sweat uncomfortably easily are not fun, but the inter-dose withdrawal effects, usually ensuing while I am sleeping and present upon awakening, are certainly much worse. When I do wake, I need my tramadol, else I don't know what I'd do, really - I don't think I'd be very functional at all, as the OP suggested in his or her experience, too. For me, the tramadol experience was really tops in the beginning, but of course that is not unordinary or odd. I remember that my morning dose of 100 mg tramadol and 10 mg extended-release mixed amphetamine salts created this ultra-mood-enhancing, ultra-anxiolytic effect, where my problems with depression, anxiety, fatigue, and chronic pain seemed to literally vanish, but that was the honeymoon period, where the synergy of the two was sparklingly remarkable in a recreational and therapeutic sense. That didn't last too long, but I remember it. Hell, I remember my honeymoon period with just tramadol - it rendered long-lasting euphoria that was really quite undeniable, as an opioid and as the atypical stimulant/anti-depressant it is. The tramadol euphoria was once superior to a sizeable dose of amphetamine or methylphenidate, now, and even superior, in its queer way, to the regular opiate. It was, at a time, like buprenorphine plus an amphetamine with no side-effects plus a disinhibiting sedative-hypnotic (it really kicked the hell out of my OCD and social phobia - obliterated). But, to rant about a brief period is not of all that much help, I guess. It is just odd how, now, it seems only necessary to take to avoid wd's, and once it was the bee's knees super drug.
I would like to add, for the OP's interest, that, in the name of harm reduction, I would try to taper your dose down little by little until you are at a dose which is neither insufferable, but not as potentially dangerous and harmful as near and up to a dose of 1 g/day. The fact that you do use certain steroids, which I know very little about, does not seem particularly wise in conjunction with the tramadol and/or the methylphenidate - I, frankly, cannot speak to the extent of potential danger of the concomitant use of anabolic steroids and/or methylphenidate. It certainly does seem unwise, however. The use of the methylphenidate with tramadol is something of which I can relate firsthand, but I take only half the daily dose you are with respect to the tramadol, so, even with relatively modest doses of methylphenidate, it does seem to pose a definite potential risk. I would very highly suspect reducing your methylphenidate dose, though not high as it is, would be relatively a subjectively easy thing for you to do; I do not know what you mean by "10 - 20 mg ED", other than the dose, but what does ED mean? In any event, I'd think even 2.5 mg to 5 mg methylphenidate would be 'better than nothing', if you are using it as a therapeutic agent and not recreationally, which I assume you are. Methylphenidate does not really incur tolerance in the same way amphetamine, for example, does; in fact, it has been my opinion that, with methylphenidate, there really is not much tolerance able to be accumulated, with regard to most of its effects, including the therapeutic ones. I, personally, use my methylphenidate recreationally more than anything, and even still there does not seem to be much tolerance build up, unlike my experience with amphetamine - remember, they work in very different ways, even if they tend to be grouped together as pharmaceutical stimulants. Amphetamine works as a releasing agent, and to a much lesser degree, a reuptake inhibitor, too - it works on serotonin, norepinephrine, and dopamine. But, methylphenidate really works as a reuptake inhibitor for norepinephrine and dopamine, and I do not think it has much effect on serotonin, if any, whereas amphetamine does. I am not certain that methylphenidate does not effect serotonin, but still the two types of drugs are very different.
So, not really knowing all of what I should about tramadol itself, I can still confidently recommend reducing your total tramadol dose by means of a taper at a comfortable rate (benzo's can help - remember to use, safely) to as low a dose as possible, but only you can really determine what good outweighs the bad, and vice-versa, with respect to rate of taper and the amount after said taper. I can still recommend confidently that you decrease your individual and total methylphenidate doses, even though I agree they would normally be considered quite 'modest' or 'light', but your tramadol/steroid use can complicate things a great deal - would you consider eliminating the methylphenidate? I would recommend, too, you really re-evaluate your use of anabolic steroids, for, though as I said, I don't know much about them, I know they are psychophysiological 'stressors' and exert a stimulant activity of their own kind; with this, I really worry about strain on the cardiovascular system - I just think a large dose of tramadol, very serotonergic and noradrenergic, can wreak havoc on the heart on its own, and anabolic steroids, I am sure, do not help this. Then, think, to add methylphenidate on top of that, even a bit, could probably have the potential to cause some really rather serious acute and chronic danger to the heart and cardiovascular system. Also, damage of the liver and hepatic system is a risk; that I know to be a risk, likely even greater on account of the combinations, here, but to what extent tramadol exerts hepatoxicity at high doses, I don't know. Tramadol is metabolized by the liver, so I'd think there be some ill effect. Thankfully, you do not use any APAP - that would just be even more concerning, in that regard.
Really, I would look at how your current use of different drugs presents particular danger because of both synergistic effects and compounded effects. I would do a serious and complete re-evaluation of all of it. I know this is somewhat of a rambling message, maybe seemingly redundant or aimless, so apologize if it is, but I hope some it helps. Incidentally, I have not heard of the adverse effects tramadol exerts on the prostate, but that could really account for some of my genitourinary issues - often there is polyuria, sometimes hesitancy and retention, sometimes urine of foul appearance and/or odor, sometimes semen in the urine, and sometimes, even, production of a fair amount of a pre-ejaculate without even erection or sexual arousal. Maybe, I ought to re-evaluate my tramadol use, but it is something which I do fear - to re-evaluate it. And, one thing to add, which I forgot about your thread, you might consider, CAREFULLY, using the Remeron to sort of replace some of the tramadol you might taper, by increasing your dose of that after reducing the tramadol intake; still, that is yet another agent which you use that could very well complicate your health because of this very risky polypharmacy going on. I don't know how much Remeron you take now, but a modest increase, after a more sizeable decrease with the tramadol might be something you could benefit from. Honestly, that might be more of a danger. Right now, I am just shooting out ideas as they are coming to me. Again, sorry for the length of this post. You are no doubt strong in character, and no doubt have enough knowledge to understand many of the potential implications of your drug use as it is, but you need to use both of those great attributes to get yourself to a better and more healthful state.
