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RCs Tramadol and Mirtazapine

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DiscoApe

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Joined
Dec 28, 2015
Messages
10
I take 45mg Mirtazapine every night. I want to try Tramadol because I have read it can be excellent for anxiety and depression.

I am worried whether this is a safe combo though, as there seems to an possible risk of serotonin syndrome. I plan to try Tramadol starting at 50mg a day.

Would it it lower the risk if I stopped taking Mirtazapine for a few days before starting the Tramadol?
 
Tramadol lowers the seizure threshold. For recreational purposes some love it and some hate. Withdrawal from it is said to be emotionally nasty for a lot of people, with long lasting after effects. Tramadol doesn't seem like a good choice as a daily for depression and anxiety. It doesn't have an indication for either ailment. Is it pain medication. Is it possible you meant trazadone? Trazadone is a antidepressant that is most used for sleep problems, a lot like mirtazapine.
 
No, the OP is right, Tramadol IS an anti-depressant.. Off label, at least.

It's a Serotonin and norepinephrine reuptake inhibitor (possibly releases them, I'd have to re-read about it). In addition it's very weak on the mu receptors hence the slight opiod effect. It also turns into o-Deso-tramadol (that's for short). Tramadol turns into Morphine via CYPD26 but only a small percentage maybe 10%.

So it has its pain relief effects by the way I mentioned above, how well just depends on how well your body converts it.

Then as far as depression goes it does have effects on both serotonin and norepinephrine, which are what SNRI antidepressants do. Although I don't recall if Tramadol does it quite as well as actual antidepressants and is as "steady" as them to make someone more balanced. Although many people have used Tramadol for depression and it has worked...

As far as it being a bad combo? Possibly for anxiety, but extremely unlikely it's going to give you serotonin syndrome. Very unlikely. Since remeron effects serotonin and norepinephrine, and Tramadol acts on Sertonin and norepinephrine, you are now getting double action at both areas. You may have INCREASED anxiety because of too much norepinephrine. That's probably the biggest issue. The chances of you getting serotonin syndrome are very low, it's almost unheard of for people to get to via antidepressants themselves, unless you are taking very large doses of Tramadol throughout the day, and combine it with another serotonin agent -- like DXM, or 5htp, etc.
 
ColoradoBoy90 - thanks that's a very helpful reply.

Do you think it would be worth dropping my Mirtazapine disease down at all though when I first try Tramadol, to lower the chance of increased anxiety? And also just to really make sure I don't get serotonin syndrome?
 
I definitely would not combine them, SS is not the only risk:

Combining these medications can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, blurred vision, muscle spasm or stiffness, tremor, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. Using Tramadol with mirtazapine may also increase the risk of seizures not related to the serotonin syndrome.
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If you have to take antidepressants Tramadol will make your depressions worse. At least when you stop taking it. It is apretty nasty drug and 45mg of Mirtazapine is not a low dose.
It is not worth the risk in my opinion.
 
Zerwas is right, this combination is dangerous, don't do it
SS and seizure are no joke and can be lethal so better be safe than sorry
If however you stop taking mitrazapine, wait a few days and then take tramadol there should be no problems
Imo tramadol is a nasty drug, did nothing but give me an headache, but everyone is different
 
Ok, very mixed reports then so far. Obviously I'll err on the side of caution and will stop taking Mirtazapine for a few days.

Interesting you say Tramadol is a nasty drug as sounds like a lot of people rate it very highly. The reason I am keen to give it a shot is that my anxiety has been resistant to medication and therapy for over a decade, and I have read reports that some people find Tramadol almost a miracle drug for anxiety.
 
Well I used to enjoy Tramadol a lot when I had no tolerance to opioids but even back then it always left me with a hangover similar to MDMA due to the Serotonine-Effects so I would recommend against it if you suffer from anxiety and depression. It will probably help during the duration of effects but make it worse after that.
But I have to say I always took at least 200mg. If you try 50mg and it works it should not have such immense negative after effects. But be aware, Tramadol can be a bitch.

Other meds for anxiety aside from the obvious Benzos are Gabapentin and Pregabalin (Lyrica). They are pretty effective but have a very hard to gauge addiction potential.
Some people experience very harsh withdrawals from these GABAergics.

I'd talk to my doctor about it.
Good luck finding something that helps!
 
Zerwas said:
Well I used to enjoy Tramadol a lot when I had no tolerance to opioids but even back then it always left me with a hangover similar to MDMA due to the Serotonine-Effects so I would recommend against it if you suffer from anxiety and depression. It will probably help during the duration of effects but make it worse after that.
But I have to say I always took at least 200mg. If you try 50mg and it works it should not have such immense negative after effects. But be aware, Tramadol can be a bitch.

Other meds for anxiety aside from the obvious Benzos are Gabapentin and Pregabalin (Lyrica). They are pretty effective but have a very hard to gauge addiction potential.
Some people experience very harsh withdrawals from these GABAergics.

I'd talk to my doctor about it.
Good luck finding something that helps!
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Thanks. I've tried Pregabalin but didn't get on with it. However, I know suffer from neurological pain so I'm tempted to try it again as it might help with that.

I think my anxiety is due to brain damage from heavy MDMA abuse, so it's likely nothing will help a great deal.

Benzos don't really help, although they do make me feel slightly better in a kind of zoned out way. However, I have abused them no end and ended up addicted twice, with horrible withdrawals lasting many months. Also I believe they may have caused my neurological pain so I am cautious of them now.

Tramadol feels like one of my last chances so I'm keen to give it a go.
 
N0 offense, put a absorbent material on your bed and floor for when you stroke out, the mess will be easier to clean up. Just sayin.. Good luck and I hope you make it.
 
I took a large dose of both Remeron and Ultram for over three years.. nothing but bliss. My PM doc knew I was on Remeron and both he and my pharmacist never said anything, and I never had any side effects.

Now the trams are gone, and my life is fucked. .
 
For what it's worth...when I was on 30mg mirtazapine a doctor prescribed me tramadol. I already knew that tramadol with ssri's were a bad idea but I decided to ask my p-doc anyways, he said mirtazapine didn't have the same risks as the more common AD and gave me the green light to take them although I never did.
 
I've skipped my Mirtazapine for 2 nights now. Am I safer to try tramadol now, or do I need to skip more doses?
 
With a half-life of 20-40 hours it depends on how long you were taking the Mirtazapine because it probably accumulated in your system if it was a longer period of intake.
I generally wouldn't risk it. Tramadol isn't worth the risk and with the psychologcal issues that lead to the need of an antidepressant, Tramadol will be counterproductive towards your problems, especially the days after using it recreationally.

If you really want to get high better obtain some other opioids. But I would also generally advise against that in your situation.
 
Zerwas said:
With a half-life of 20-40 hours it depends on how long you were taking the Mirtazapine because it probably accumulated in your system if it was a longer period of intake.
I generally wouldn't risk it. Tramadol isn't worth the risk and with the psychologcal issues that lead to the need of an antidepressant, Tramadol will be counterproductive towards your problems, especially the days after using it recreationally.

If you really want to get high better obtain some other opioids. But I would also generally advise against that in your situation.
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Couldn't have said it better.
When you start taking it more often you will grow a tolerance, but with tramadol you can't go over 400mg without risking a seizure, so better look in different antidepressants like tianeptine or stuff like that:)
 
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Tramadol is horrible, don't bother. From what I've seen the wds are psychologically vicious
 
I wouldn't combine them not in a million years. But then again, I have personal experience with the bad side of it. Let me preface this by saying that I using my Tramadol (which I love, btw) recreationally, and I was on another SSRI in addition to mirtazapine. I'd been on the SSRI's for several years, was placed on Tramadol a year earlier, and had used them without incident for that time.

I was driving home from work one afternoon, was 1/4 mile from home, and the next thing I knew, I woke up in the back of an ambulance. I apparently had a low-speed crash into 2 other cars. Bystanders who came to help reported that I was in a full grand mal seizure. (Never had a seizure before in my life, and I'm 49 years old.)

I was seen in the ER, afterward by an orthopedist and also by a neurologist. NOBODY mentioned that Tramadol lowers seizure threshold. I also then had another witnessed grand mal about 2 months later. Still, the neurologist said nothing, but did put me on anti-seizure meds.

It wasn't until a few weeks later that I injured my hand & went to an urgent care clinic. The doctor agreed that the injury would cause me some pain & said she would prescribe Tramadol. I told her, I've got that at home so don't worry about it. As I said that, she was typing in her iPad, and said, oh no, not giving you Tramadol. I asked her why, and she said that when she tried to type it in, it gave her a big red flag for drug interaction. She ordered me Vicodin instead.

i have since :) changed neurologists.
 
Don't take stop taking mirtazapine to take tramadol, you'll likely get nasty wd from the mirtazapine and the tramadol won't help. Seriously, the fastest way for me to go from ok to suicidal is stopping mirtazapine to take recreational drugs (which I have, and it was horrible). Opioids aren't really the way to go for depression anyway.
 
morphine-dreams said:
Don't take stop taking mirtazapine to take tramadol, you'll likely get nasty wd from the mirtazapine and the tramadol won't help. Seriously, the fastest way for me to go from ok to suicidal is stopping mirtazapine to take recreational drugs (which I have, and it was horrible). Opioids aren't really the way to go for depression anyway.
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Good advice, wish I'd thought to include that as well.
 
I take seroquel XR (750mgs at night-metabolite acts as an SSRI next day), mirtazapine (15mgs at night, 30mgs in morning; an NaSSA and part phenethylamine), and vyvanse (60mgs in morning) every day and took 60mgs dextromethorphan with 9 grams Bali kratom yesterday and I didn't have a hint of Serotonin Syndrome at all. Zilch.

I'm no Doctor, and don't misinterpret this as 'not harm reduction', but I think you'll be fine.
I would be more concerned with adding cimetidine to that combo as it increases blood levels and cMax of both drugs.
 
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