Opioids Tramadol snuck up on me - SNRI

[jb2020]

Hi,

I'm new here. I found your forum and can't tell you how relieved I was to read the non judgmental advice and support. I know that my case is minor given the doses involved, but I would really appreciate some help.

I could write for days but I'll keep it short. I was in an accident 10 years ago and compressed a disc. After cycling through a few different meds (temgesic, morphine SR and some others) I finally found that tramadol worked really well except some initial trouble with nightmares.

After the disc compression started improving (this took time - almost 6 months) I came completely off everything for a while, maybe even a year. At some point I must have needed some extra pain relief so took some of the tramadol. I should say here that I suffer a little from OCD, social anxiety and attention deficit. I found that the tramadol gave me a very mild euphoric state, but the main positive impact was that my OCD improved, my social anxiety reduced enough to be background noise vs right in my ear and I was able to focus really well. Until I started researching I didn't understand the science behind it, but I guess it's the SNRI component of the drug.

Since then I've been taking a really low dose for 8 years - literally just 50mg twice a day. I've been super successful at work, better at interpersonal relationships and feel like a better person. It was always on my mind though, like I was cheating or something, and was typically consumed with constantly thinking about when the evening dose was coming up. I recently moved with work and as it was pretty stressful I upped my intake to 3 times a day (so just 150mg total) which helped in the short term but longer term it evened out and started worrying me.

Realizing that I have an addictive personality, I abruptly stopped a week ago. I missed a dose and had a good day so it propelled me into kind of a 'new me' mode. 6 days on, I have not had a good week at all. Again I know the dose here is minor so I guess I went through minor withdrawal - cold like symptoms, aching, and an almost total inability to sleep. I finally had the doctor prescribe me some temazepam so I could at least get a few hours. PS as far as doctors are concerned they think the tramadol is for 'breakthrough pain', I've never talked to them about this.

I'm finally coming out of it on day 6 and reducing the sleeping pills but here's my dilemma: I don't miss the high - after 8 years it was virtually nonexistent - I miss the SNRI qualities. I have a really demanding job and I'm already finding trouble maintaining attention and my OCD kicking back in a little.

I guess I have 3 options here:

1) Accept that this is me, try to work through the attention/OCD/social issues to find a new normal
2) Go back on the tramadol low-dose twice a day
3) Talk to my doctor and get an SNRI - this might be difficult because of my work and it going on record, but also the SNRI affects of Tramadol are mild and I might end up getting something stronger without realizing it and causing more problems

I could really use some advice. I'm really tempted to go option 2 but I have an opportunity to at least make that decision now that I've gone through the hardest part of stopping. Thanks in advance

 

[andrek159206]

i take tramadol sometimes, its great for social anxiety and depression, its not a big problem take sometimes, an its really good to work with him,but i take like 400mg a day.

 

[MsDiz]

I would speak to your Dr about a SNRI. Ask for a mild one.

 

[Xorkoth]

That's fortunate for you that it sounds like you didn't get much in the way of withdrawals after so long taking them daily. But as you seem to know, opiate addiction is nothing to mess with, so good for you for stopping, it's good to know you can. I think the best bet would be an SNRI prescription, probably, but I think some of them have much w0orse potential side effects than tramadol. Also they can be very physically addictive, you might end up with an actual physical dependence, whereas with tramadol it appears you are able to dose it in small doses daily and avoid serious dependence.

Just some thoughts. Tramadol could be the right medicine for you, maybe, it sounds like the risk to reward ratio is quite favorable. But I would hate for you to slip into opiate addiction. As someone who has struggled with opiate addiction for going on half my life, it is a curse I wish upon absolutely no one.

 

[supersonic89]

Maybe it's time to try some SNRI and see how it goes. I have had good results with venlafaxine in the past (structure very similar to tram). But, you should keep in mind that antidepressants aren't immediate action (like tramadol), so you should be patient for at least 1 month.

I also recommend you to exercise more, sleep and eat better because that can help a lot with mental disorders (I know because I also suffer from some social anxiety and depression).

P.S. I also had a herniated disc problem and prescribed me tramadol but, unlike you, I began to abuse it after some months (and I had never had a history of abuse of alcohol or other substances). I still take it, even though my back is healed.

 

[GetMeOutOfThisCRAP]

Once you get too used to the opioid feeling it's so hard to undo if even possible? Chronic pain or not/OCD/etc no one is immune to withdrawals and the changes in the brain that occur with dependency. It sounds like this thread shows that.

Your doses are small enough that any decision wouldn't have grave consequences in my opinion. So I wouldn't dwell on the topic whatever you do decide! I'm definitely familiar with OCD lol. The old family member I'm currently a caretaker for has it... It's definitely a legitimate condition. Anti-depressants do help with OCD quite a bit (but old doctor was a criminal and vanished without tapering him off so we're all left to suffer from his OCD rebound ). Cheers to doctors everyone!

 

[jb2020]

Thanks to everyone for your support.

@Xorkoth I also read your opiates retrospective and was really moved by the candor and pain people like yourself go through. It makes me feel as though this issue is just a drop in a very big ocean, so I am almost guilty for sharing!

Thanks to others like @PrincessDiz and @supersonic89 for the SNRI reco too. If I knew it would work then I would do it, but 4-6 weeks is a long time for something that might not work and as someone else mentioned I could easily be looking at side effects or increased dependency whereas I know Tramadol works for me.

I've been out a week and a half now so I know I can manage without (this is important to know) so I think my next step is to go back on them but stick to the 100mg limit I managed to stay on for several years.

My retrospective is that I hate how messed up we are as a species; I can't even tell you why that is, evolution/environment/upbringing maybe. I work really hard at work, to take care of my partner, strive to be healthy etc., yet OCD and attention deficit is something I've always been plagued with and until I started on this accidental medication I had no idea that these things were 'fixable'. Now several years on I have to make these tough calls and feel pressured with the constant feeling that I'm somehow cheating the system while putting something nasty in my body. I also hope that if I fast-forward 30 years that this stuff (even at low dose) isn't responsible for taking years off my life or something. I'm still lucky, but I just wish things were a little easier is all. Sorry for ranting but it feels cathartic to at least get it out there.

 

[MsDiz]

Just want to say..... a hell of a lot of people start out saying I can handle it, I can keep it to 100mg etc etc...

opioids and especially tramadol are nasty drugs with horrid side effects. It starts out all good and easy breezy but they only end up doing to you what you were taking them to avoid.

 

[supersonic89]

I think the best bet would be an SNRI prescription, probably, but I think some of them have much w0orse potential side effects than tramadol. Also they can be very physically addictive, you might end up with an actual physical dependence, whereas with tramadol it appears you are able to dose it in small doses daily and avoid serious dependence.

Are you sure about this pal? I didn't know SNRIs could be addictive.
During 2012-2014 I took venlafaxine and in fact I quit cold turkey without major problems (maybe the classic brainzaps and some lethargy but nothing serious).

To @jb2020, I don't see anything wrong with taking tramadol off-label for depression. Especially if your consumption is super controlled. I don't see any difference between you and a guy who takes sertraline or prozac every day in therapeutic doses. I wish I could take tramadol like you do.

 

[Fairy of the Flowers]

I started low dose, ended up on 6-8 x 50mg a day, they're a bitch to come off as not only are you having to go through an opioid withdrawal but an SNRI one too, the withdrawal was so bad I've barely touched them since, probably had 10 since I quit, and this was over a year and a half ago, put it this way I'm off and on benzos after quiting though around the same time, but I've not gone back on tramadol even though I've now been diagnosed with fibromyalgia and can get thrn online if I want to

 

[Xorkoth]

Are you sure about this pal? I didn't know SNRIs could be addictive.
During 2012-2014 I took venlafaxine and in fact I quit cold turkey without major problems (maybe the classic brainzaps and some lethargy but nothing serious).

To @jb2020, I don't see anything wrong with taking tramadol off-label for depression. Especially if your consumption is super controlled. I don't see any difference between you and a guy who takes sertraline or prozac every day in therapeutic doses. I wish I could take tramadol like you do.

There are a number of reports on Erowid of Venlafaxine cause serious withdrawals. I have never taken any SNRIs except tramadol at times (when I was already addicted to opiates, and tramadol doesn't really do it for me at all), so I don't know personally. But I know for sure that SSRIs and SRIs are addictive and have withdrawals, and SNRIs inhibit the reuptake of serotonin as well. I have also talked to people in here who say they've never gotten withdrawal from SSRIs, but it seems that most people do, it's certainly a medically recognized thing.

A lot of people addicted to tramadol report additional withdrawal effects beyond opioid withdrawals... same with tianeptine, which is an SRI as well as an opioid.