Can Tramadol induce Hypomania in a % of users reporting an AntiDeppresant effect?

[Anoymator]

I have been pondering this question for quite some time now.

There seems to be a % of users who use tramadol for its antidepressant (AD) rapid effects, I am one of them and I have read of similar experiences from others in this forum and on the internet. Instead of using tramadol for what it is supposed to be (painkiller), some people find its benefits to be of an AD nature albeit of a different nature than conventional SSRI-type ADs.

I have been using tramadol for some years and every time I have looked back at what I have done when I was using tramadol, what I have accomplished screams of hypomania: mild euphoria, increased social drive (to the point of becoming dangerous/time wasting), increased empathy, increased energy, increased creativity, grandiosity and foolishness. I used to get this from small doses 100-150mgs although these days I need 250mgs to get to this level due to tolerance. My use (abuse) of tramadol has always been for this marked benefit, never for the painkilling properties of the drug. In fact, this AD-esque effect only lasts 4 or 5 hours and then I enter a 2nd phase marked by analgesia which I dislike (the AD effects wear off in this 2nd phase, coinciding with the half-life of the drug and the metabolizing of tramadol to the o-desmethyl form).

Looking at the structure and pharmacology of tramadol, I cannot help but wonder if tramadol is activating hypomania in me and a subset of users of the drug who, like me, find this drug to be unique in terms of its AD effect. I have ADHD (diagnosed) and I suspect a bipolar disorder too (undiagnosed but suggested by doctor). I have a prescription of methylphenidate and no matter how much I take (abuse), I never get the same effect as tramadol, no other drug has me achieving this unique AD effect other than tramadol.

I was contemplating using tramadol long-term to reap this AD effect. However, as I say, every time I look back to what I did while using tramadol, it screams hypomanic and it has made me do dangerous stuff as well as waste my time on a lot of stuff (all while euphoric and with grandiosity). I have a lot of energy and motivation but I am all over the place and have done a lot of foolish acts due to tramadol-induced misjudgement. Since SSRIs are known to activate hypomania in a % of users I was wondering if tramadol would also be capable of this too as tramadol has a unique pharmacology in that it seems to release serotonin AND cause its reuptake too. I have never used SSRIs though but as I say, no other drug (including stimulants such as amphetamine or methylphenidate) can bring this stimulating AD-esque effect in me: this has made me take tramadol as my Drug of Choice for years, I haven't used other drugs.

 

[polymath]

You might find this article interesting:

http://www.ispub.com/journal/the-in...e-to-tramadol-may-herald-bipolar-disease.html

Abstract

Background

The association between Tramadol and mania has been reported in a few anecdotal reports. Case Presentations Three cases of mania coinciding with Tramadol administration are presented. The patients all reported excellent analgesic response to Tramadol after it was restarted in combination with a mood stabilizer. Conclusions These cases suggest a possible association between Tramadol and mania. Intolerance to Tramadol may even signal an underlying untreated manic depression. In this case, consideration should be given to restarting the Tramadol in combination with a mood stabilizer.

 

[villian]

I had to quit tramadol because it was making me manic; I was also using it as an AD rather than a painkiller. I hardly felt any mu agonism from tramadol, it was almost a completely serotonergic feeling and much more effective than traditional anti depressants. It pretty much eliminated my anxiety and depression for awhile but eventually it started making me manic and extremely irritable as well as causing insomnia. Withdrawal was a huge pain in the ass.

Anecdotal evidence is all I got for you sadly.

 

[Anoymator]

Wow, how had I not come across that one? I have researched tramadol quite a bit although I hadn't really looked at the bipolar association in any depth yet.

Thank you, it's actually paralleling my case and sheds a lot of my light to this. Perhaps I should have worded the initial post to suit more the ADD character of this subforum as I truly think there is something to this in a deep level.

For what is worth, I am scripted methylphenidate for diagnosed ADHD and I cannot take it as it causes me extreme side effects, I believe this reaction is typical for those with bipolar disorders. It's unbearable.

May I say that along with the effects that tramadol causes in me, it also causes unreal (pun intended) derealization, especially when the AD effects wear off. I actually feel like I am not living a real life and has causes me anxiety episodes in the past.

Thank you again, great find.

 

[Anoymator]

I had to quit tramadol because it was making me manic; I was also using it as an AD rather than a painkiller. I hardly felt any mu agonism from tramadol, it was almost a completely serotonergic feeling and much more effective than traditional anti depressants. It pretty much eliminated my anxiety and depression for awhile but eventually it started making me manic and extremely irritable as well as causing insomnia. Withdrawal was a huge pain in the ass.

Anecdotal evidence is all I got for you sadly.

I think anecdotal reports should be encouraged, thank you for bringing in yours.

I have been digging into the archives of this forum trying to find some answers so I think a thread looking at tramadol from this point of view would be helpful. I truly think that tramadol is doing some dirty mania-inducing stuff to a % of users who report the strong AD effect that tramadol gives. I personally know of other people in real life who get no AD effect from tramadol yet I find similar cases to mine in drug-related forums (drug addiction and bipolar seem to have a strong association so it would be normal to find anecdotes in forums devoted to drug use/abuse).

The sublime effects from even low doses (150 mgs) seem to be only caused in a % of users and perhaps these users are bipolar, don't know it and are causing themselves long-term damage. I know I have done some fucked up shit on tramadol (on only 150mgs) that screams bipolar and has affected me negatively in my life.

 

[Mr Smokes Blunts.]

When I was using tramadol for an extended period of time (a few years), I got the exact symptoms you are suggesting. It just fed into this state where I constantly felt like I was on super fine form and I was zooming through life. I was probably sleeping a few hours a night too. I don't think i'm bipolar, but I have a tendency to get miserable, and I never felt miserable while I was using tramadol. The trouble comes when you want to stop taking tramadol. The withdrawals are worse than morphine withdrawals, and I would estimate it took me a few months to feel anywhere near normal. The opiatey part where I was just kicking and flailing in bed for days was probably the easiest part, it was the constant anxiety and depression not unlike an ecstasy comedown that dragged on and on that almost drew me back to taking it. If you look through the addiction forums for tramadol you will notice that it is a very specific sort of person who gets addicted to tramadol, and that sort of person is like you or I - they get an AD effect from tramadol. In the end I just got totally fed up of being wired and buzzing constantly and had to give it a rest, it was pretty much like taking a weak E all day every day to be honest.

I know this is also annecdotal, and also a bit of a mess to read, but I hope you found it useful anoymator

 

[Anoymator]

When I was using tramadol for an extended period of time (a few years), I got the exact symptoms you are suggesting. It just fed into this state where I constantly felt like I was on super fine form and I was zooming through life. I was probably sleeping a few hours a night too. I don't think i'm bipolar, but I have a tendency to get miserable, and I never felt miserable while I was using tramadol. The trouble comes when you want to stop taking tramadol. The withdrawals are worse than morphine withdrawals, and I would estimate it took me a few months to feel anywhere near normal. The opiatey part where I was just kicking and flailing in bed for days was probably the easiest part, it was the constant anxiety and depression not unlike an ecstasy comedown that dragged on and on that almost drew me back to taking it. If you look through the addiction forums for tramadol you will notice that it is a very specific sort of person who gets addicted to tramadol, and that sort of person is like you or I - they get an AD effect from tramadol. In the end I just got totally fed up of being wired and buzzing constantly and had to give it a rest, it was pretty much like taking a weak E all day every day to be honest.

I know this is also annecdotal, and also a bit of a mess to read, but I hope you found it useful anoymator

Yes! Like a weak E, that's the parallelism. When I would say tramadol would feel like a weak E people would not believe me, but I know myself and a few others have voiced this.

Have you tried to see if you are bipolar? The miserable part sounds like me too and in the past I would cycle from feeling miserable to feeling bizarrely on top of the world. This was without taking drugs, much of my adult life and teenager life has been like that, actually. My doctor suggested it could be bipolar but that I need to be assessed by a specialist.

With tramadol, no matter how bad I felt, take a few pills would have me in what looked like manic. In fact, I got myself hooked on this when I was going through a depressive phase of my life which had been preceded by feeling awesome (again, no drugs involved).

I think this is serious and that tramadol should not be taking lightly in those who like you and I are getting these atypical effects.

How have you weaned off tramadol, did you seek professional help or have you been self-medicating with anything else?

 

[Mr Smokes Blunts.]

Yes! Like a weak E, that's the parallelism. When I would say tramadol would feel like a weak E people would not believe me, but I know myself and a few others have voiced this.

Have you tried to see if you are bipolar? The miserable part sounds like me too and in the past I would cycle from feeling miserable to feeling bizarrely on top of the world. This was without taking drugs, much of my adult life and teenager life has been like that, actually. My doctor suggested it could be bipolar but that I need to be assessed by a specialist.

With tramadol, no matter how bad I felt, take a few pills would have me in what looked like manic. In fact, I got myself hooked on this when I was going through a depressive phase of my life which had been preceded by feeling awesome (again, no drugs involved).

I think this is serious and that tramadol should not be taking lightly in those who like you and I are getting these atypical effects.

How have you weaned off tramadol, did you seek professional help or have you been self-medicating with anything else?

I haven't had any psychological assessments before. Unless you're posing a serious problem, or have a serious problem, it is very unlikely your mental health will ever be looked at beyond perhaps depression in the UK. Looking back my tramadol phase did coincide with a depressive phase, but also an ill and down phase in general. When I decided I wanted to quit, I had been using a 2-4 pills a day for quite a while, then in the run up to a large operation where I was in a lot of pain I got upto about 500-750 mgs per day, and once i'd had the op I decided i'd had enough and just stopped completely. The doctor said don't do that but it had to be done. Tapering for me is just leaving the door to easily justifying reescalating my use whenever I feel like it. I do however use cannabis and benzos frequently. I'm still pretty sure i'm not bipolar, even though I haven't been assessed. My mood does cycle, but it is probably too rapid to be described in that way. I also wouldn't say that the swings to either end of the spectrum ever get too deep.

 

[villian]

Have you tried to see if you are bipolar? The miserable part sounds like me too and in the past I would cycle from feeling miserable to feeling bizarrely on top of the world. This was without taking drugs, much of my adult life and teenager life has been like that, actually. My doctor suggested it could be bipolar but that I need to be assessed by a specialist.

I am diagnosed bi-polar. I have self medicated constantly with this or that (polydrug) over the years so I can't give an assessment of my sober behavior.

 

[Epsilon Alpha]

This might belong more in the "healthy living" or "other drugs" subforums, my personal experience with tramadol was much like trazadone. I turned into a hyper, creative asshole, wait... that's baseline.

But, after I cracked some ribs it made me really stimulated in an unpleasant way.

 

[skillet]

How strong a NRI is it? I took reboxetine for a couple of weeks when I was a lot younger and it felt (from my limited experience at the time) fairly similar to amphetamine.

 

[negrogesic]

I am not challenging the validity of that link, but some of those internet publications feature articles that are 'odd', poorly-written/reviewed, and original publications from such sources are not frequently cited in the work of more 'established' journal. To be quite frank, I will admit to having used such a source to emphasize my own personal views that I knew had not been otherwise properly documented.

Ms. H was a 45 year old female with a history of bipolar disease and subtalar arthritis asking for a breakthrough pain medicine in addition to the methadone she was already receiving. After starting Ultram ER 200mg/day, she complained of nausea, diffuse abdominal pains and increased pain levels. The Ultram was discontinued and Lithium was started. Two weeks later she was restarted on Ultram and stated that her pain levels were well controlled without any of the prior side effects.

This report is odd, as tramadol is rarely considered to be a break-through analgesic during methadone treatment, and the nausea and 'increased pain levels' would seem to suggest a tramadol-precipitated methadone withdrawal. Granted, it goes on to say that the tramadol was tolerated upon addition of lithium, but this is unclear and somewhat questionable.

 

[sekio]

Why would you prescribe an ER medication for breakthrough pain?

 

[Anoymator]

This might belong more in the "healthy living" or "other drugs" subforums, my personal experience with tramadol was much like trazadone. I turned into a hyper, creative asshole, wait... that's baseline.

But, after I cracked some ribs it made me really stimulated in an unpleasant way.

Feel free to move this thread.

I posted it here as I thought more knowledgeable people would be able to confirm any associations with bipolar/mania as there are many user experiences posted about tramadol that parallel mine, yet the drug offers a dichotomy of effects too. I hadn't seen any threads with anything trying to pinpoint a reason for the reported strong AD effect that tramadol has in a sub-set of users, and whom they themselves may be risking their lives by possibly inducing mania which is mistaken for an AD effect.

As I have reported, tramadol has me acting in a bizarre way while mildly euphoric.

 

[Anoymator]

Subjectively, it feels amphetamine-like with a touch of empathy and social lubrication.

All in a very bizarre way, this effect lasts for 4-5hours and slowly fades into a cranky/moody dirty sedated effect (odesmethyltramadol is a NRI lacking 5HT modulation and has opioid activity much stronger than tramadol and similar to codeine). I also feel mild derealization and tramadol has NMDA antagonist activity (according to Wikipedia).

 

[Achten]

I can't add anyting to this but I have a tramadol related question:

If I take +/-120mg Tramadol on Day 1 10h30am, can I safely (relatively, of course, nothing is safe) take a phenethylamine or tryptamine on Day 3 20hpm ? I'd say yes because of the 7hour halflife, but still I'd like your input.

Thanks in advance !

 

[paranoid android]

Well i have bipolar disorder and tramadol has induced mania in me and possibly mixed state mania. It was not the enjoyable type of mania at all it was the very irritable i want to smash something mania. Tramadol is a SNRI i think isn't it? The only other SNRI Ive taken is venlafaxine which triggered awful mania in me and i would never touch it again with a 10 foot pole.

Thankfully my doctor now has tramadol down as a list of medications that i can't take due to adverse reactions so i don't have to worry about the shit anymore.

 

[Anoymator]

I can't add anyting to this but I have a tramadol related question:

If I take +/-120mg Tramadol on Day 1 10h30am, can I safely (relatively, of course, nothing is safe) take a phenethylamine or tryptamine on Day 3 20hpm ? I'd say yes because of the 7hour halflife, but still I'd like your input.

Thanks in advance !

From my reading on others threads covering the use of tramadol and serotonin-type psychedelics, a 2 day (48 hour) washout period is the minimum safe period. Also, 120mgs of tramadol is a fairly low dose but I believe it was Shangles (sp for username?) who had SS with 100mgs of tramadol in the morning and taking LSD in the evening.

Wait for someone more knowledgeable though.

 

[Anoymator]

Well i have bipolar disorder and tramadol has induced mania in me and possibly mixed state mania. It was not the enjoyable type of mania at all it was the very irritable i want to smash something mania. Tramadol is a SNRI i think isn't it? The only other SNRI Ive taken is venlafaxine which triggered awful mania in me and i would never touch it again with a 10 foot pole.

Thankfully my doctor now has tramadol down as a list of medications that i can't take due to adverse reactions so i don't have to worry about the shit anymore.

Thanks for reporting. The interesting part of tramadol is that it seems to also release serotonin apart from causing its reuptake which yields a very interesting albeit dirty drug. Its different actions on a neurotransmitter level plus its lowering of the seizure threshold make for a drug which is too dirty and cannot be combined with most psychotropics. I am surprised doctors give it out like candy though and I have a script for methylphenidate (to take it daily which I don't) yet doctors or pharmacists never warn me about using tramadol with methylphenidate (my supposed daily dose of MPH is high for ADHD and it would interact badly with tramadol if I were to combine them as per doctors orders).

Quite a unique drug, for good and bad.

 

[Sprout]

Definitely a link - the tramadol induced mania is what got me diagnosed as a psychotic cyclothymiac.