Opioids Antidepressant medications to facilitate effective transition off tramadol?

[Jabberwocky]

Hi all, I'm interested if any of your know of any antidepressants that might be particularly valuable when dealing with the non-strictly-opioid type side effects of getting off tramadol. There is a user in SL who is struggling with depression related side effects after getting off a high dose tramadol habit who believes his issues are more related to tramadols action as a kind of antidepressant (what, does it act a bit like an SNRI, I forget), as opposed to its opioid like effects.

It's kinda complicated considering he is also dealing with a pretty radical oxycodone taper, but I'm just curious if any of you have had any lucky dealing with side effects of coming off tramadol using antidepressant(s).

For the thread in SL about this, see: http://www.bluelight.org/vb/threads/813531-Taking-the-jump-or-not-tram-oxy

Thanks!

 

[Shaleh]

TPD,

Im not a huge fan of antidepressants for many reasons. However, many have used ADs and do fine.
Be cautious with some mixing witg tramadol due to Seratonin Syndrome.

Ive heard several people used Wellbutrin to replace trams, but I haven't no personal experience.

Consult medical advice, please.

 

[Hodor]

TPD,

Im not a huge fan of antidepressants for many reasons. However, many have used ADs and do fine.
Be cautious with some mixing witg tramadol due to Seratonin Syndrome.

Ive heard several people used Wellbutrin to replace trams, but I haven't no personal experience.

Consult medical advice, please.

It depends - Wellbutrin is an effective NRI, and as such should be somewhat effective against chronic pain; it is, however, not serotonergic, meaning it won't help much with the antidepressant discontinuation syndrome (brain zaps, irritability) that is part of Tramadol withdrawal.

Anyway, while I would indeed be careful about getting off Tramadol and getting on antidepressants simultaneously, I see no problem with starting to take an antidepressant, say, 48 hours after your last Tram (around the time the brain zaps would normally set in). At that point, there will be barely any unmetabolized Tramadol left (most of it having been de-methylated to the non-serotonergic O-Desmethyl-Tramadol and/or excreted), so you should be good.

 

[SKGilroy]

I'm very well versed in all things tramadol related, especially W/D. Background: started for the right reasons 15 years ago. These made me feel like a superhero----for the first 10 years. We all know about increasing dose due to tolerance; I won't bore you with all details but between 01/13/17 and 01/18/17 I used a total of 360 50mg tablets. 50-70 per day was not abnormal for me and yes, I should be dead. Due to a shipment delay I realized I would be without for 6 days. This is at least the 15th time I've gone thru W/D so I knew what to expect. Day 1 I did the usual, Imodium, Advil and klonopin. After some research I figured I'd throw in some Wellbutrin. As my 'habit' has ruined my ability to take a normal dose of anything I started with 450 mg of Wellbutrin in the AM and 450mg at night. I also used Imodium at a very high dose for the 1st 3days. So yes, from hour 12 thru hour 96 I drug myself thru the typical hell of withdrawal. And then, a FREAKIN' MIRACLE!!! No brain zaps, RLS is 1/2 of normal. For those who say it takes 4-6 weeks for Wellbutrin to kick in: you are just flat out wrong. For the first time in 15 years, after 15-20 attempts to quit this is the time. I've never felt so confident about quitting before. Also: please don't try doing what I did. It can be dangerous, especially the acute W/D week AND ESPECIALLY the Wellbutrin. High does can cause Serotonin Syndrome and that can kill you.

 

[Slow_Mobius]

Could kratom kill two birds with one stone, helping with both the oxycodone and tramadol WD? It can have a good antidepressant effect

 

[Stilltrying]

As starter of the thread in SL I can add that I have both Venlafaxin and Mirtazapin at hand. Both SNRI if I'm not mistaken.
Thing is that both these, at least according to the doctor, takes about a month to start work as they should. And that I should feel even more depressed before they kick in.
Which I'm kind of scared about. Need the effect now.

Can also mention that I've f*cked up my tapering/"body adjustment" plan.
More on that in the other thread mentioned in the first post.

 

[Slow_Mobius]

I don't think venlafaxine would take that long to work. I haven't taken it, so I can't speak from experience. However, it's structurally very similar to tramadol. Venlafaxine is basically tramadol without the opioid activity.

 

[meemaw]

Trouble is, you're going on antidepressants to get off a Tramadol habit, but what does the doc plan to give you to get off the antidepressants? I've taken Venlafaxine before and trying to come off it wasn't nice. For a lot of people (myself included) getting off SSRI's is hard - doctors have little awareness and the pharma companies pretend it doesn't happen at all.
Is it possible for you to do a really slow taper off the tramadol? The recommendation among those who struggle with getting off these types of drugs is to taper 10% of the current dose every 4-6 weeks.

 

[Stilltrying]

Trouble is, you're going on antidepressants to get off a Tramadol habit, but what does the doc plan to give you to get off the antidepressants? I've taken Venlafaxine before and trying to come off it wasn't nice. For a lot of people (myself included) getting off SSRI's is hard - doctors have little awareness and the pharma companies pretend it doesn't happen at all.
Is it possible for you to do a really slow taper off the tramadol? The recommendation among those who struggle with getting off these types of drugs is to taper 10% of the current dose every 4-6 weeks.

I'm not using any AD right now. Have some leftovers from years back. Still within expiring date though.
I'm not that big fan of AD. As you say just another thing to wean off.

I quit the Mirtazapine CT, the weight gain drived me crazy. That wasnt easy. No major physical wd symptoms but it felt like the brain was on its way out through the ears.
Never used used AD since.
The Venlafaxine box is untouched.

Regarding the Tram taper I'm already "done" with taper.
I.e. I were out of them since a couple of weeks. Moved over to oxycodone with the plan to taper one thing at the time.
The serotonin part first then the opiate.

But think I went too fast. Got from 800mg a day to 25mg in a month. With a few days overlapping with oxycodone in quite equivalent dosage.

Using some 5htp now. Might beven better than nothing.

 

[meemaw]

That was fast, is the oxycodone helping symptoms? If so, I'd stay on that a while longer, till I was feeling a bit more stable from the tramadol wd, before tapering that too. Or if you're dealing with chronic pain can you maintain a stable, prescribed dose on the oxycodone? I had nerve pain after I herniated a disc, it was awful and had me practically bedridden for nearly 3 months in total, so I can empathise.

After CTing a decade long Prozac prescription, I'm not a fan of ADs either. Noone really knows how they work, as the low serotonin "chemical imbalance" theory has largely been disproved, but they affect your brain's wiring (neurotransmitters), in essence. So when you come off them, you or your doctor might think, my depression is coming back, I must need the pills, when really it's the fact that your brain is no longer getting the thing its been used to getting and has rewired itself to deal with. So you get meltdown: depression, anxiety, insomnia are just a few of the wd/PAWS effects. A lot of ppl are put on ADs or AD-type drugs like tramadol for pain or other issues, then get told they must actually now have a mental illness when they stop the drugs and start getting mental symptoms, so they're then put on a cocktail of psych meds and are landed right on the pharmaceutical merry go round.

Win-win for big pharma. But that's a separate rant.

At another forum I lurk on they recommend magnesium supplementation to help with withdrawal symptoms like aches, insomnia, anxiety (tablets, powder or epsom salt baths) and omega 3 fish oil. Plus using techniques against anxiety like EFT tapping, guided meditation (loads of them on youtube), claire weekes' writings/videos, stuff like that. Basically gaining coping mechanisms to help ride it out. If the 5htp is helping keep taking it. I've also heard melatonin can be good for WD-induced insomnia.

 

[Stilltrying]

Yes, my plan is to stabilize on a prescribed dose of Oxy. As I need them for the pain.

The Oxy, even if very low dose, is helping a quite lot for the WD.
Only main things is the depression, lack of appetite and some sleep trouble.
The biggest issue is the cravings.
My mind know that all of the above will disappear with more oxy.

Have been using the whole Thomas recipe since the start of the Tram taper. Including magnesium and potassium.

Will try to get some melatonin on top of that.

But seems like the only thing to do is to wait it out.

 

[meemaw]

Sounds like you're doing everything you can, and even though you tapered fast the brain has a remarkable ability to heal itself over time (I'm told).

I'm just over 3 weeks off codeine for the nerve pain I had last year. I was doing ok I thought, got over the initial physical withdrawals, until this week my back pain ramped up and I really want to take some again. I never thought that could even happen on codeine, my doctor told me it wasn't addictive and he's got patients that have been on it for years (hmm, yeah, maybe they're dependent on it?!) I don't think I'll ever trust a doctor with a prescription pad again. Was already going through prozac withdrawal, just stick an opiate wd on top Doc.
Although I don't think I'd have coped with the pain without the codeine, it was the only thing that helped at all. And it was me who kept taking it after I needed to. I just got to liking that chilled out, warm fuzzy feeling. I'm trying some herbs that are supposed to help - Skullcap is good for nerve pain/sciatica and also a mild sedative/anti-anxiety, and Milky Oat tincture for addiction especially to opiates, and I'm going to give Valerian a go too. Tinctures (where the herbs are macerated in alcohol and you take a certain number of drops a day) are supposed to work better than capsules. I've only tried the tinctures but 20 drops of Skullcap tincture sends me straight off to sleep.

 

[Stilltrying]

Sounds like the herb thing isn't a bad idea. No nasty side effects etc.

I have some for sleep Alimemazine, Theralene. It works for sure.
But you'll be like a walking dead for two days.
Only used it twice and you cannot maintain a normal life afterwards.
Worst side effect ever, never again.