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Opioids Help with Tramadol combined with Cymbalta / Wellbutrin

colpeterson

Greenlighter
Joined
Oct 12, 2015
Messages
9
Hi Guys! I happened to stumble onto this sight last week while researching. I've had some mild anxiety and depression issues most of my life, that I inherited from my Mom. By mild, I mean not so crippling as not being able to function


I injured my back while playing rugby last fall, November 2014. The pain and soreness is on the left side of my back, just at and under the bottom of my ribcage, and extending down diagonally a bit towards my waist. After trying to deal with the pain for about 6 months, I went and saw my primary doc who put me on diclofenac as an AI and advised to try RICE for 30 days. That didn't do anything for me, and in fact the back pain continued to get worse during that time. She then referred me to a physical therapist. They put me on a 6 week program of some stretches and hip strengthening workouts, as they thought the pain was because my hip mucles were a little weak and putting too much strain on my back. I completed the program but had very little results in the way of pain reduction. I then went back to my primary doc as I was now starting to have trouble with the pain waking me up at night, causing me to lose sleep and feel even worse during the day. She put me on Tramadol 100mg/day and changed my AI to Naproxen. The first day I took 100mg of the Tramadol, I felt absolutely amazing. For the first time in a year, the constant pain in my back was gone. I'd almost forgotten what it had felt like to be pain free. I continued on taking 50mg tram each morning, and then another 50mg after lunch. This kept the pain at bay pretty well. If I did my back exercises, I could still feel the muscle was sore when pushing on it, but it didn't hurt all day like it had before. My primary doc then referred me to a back specialist at a highly rated hospital locally. It was a 4 week wait to get in to be seen, during which I continued the Tramadol + Naproxen usage, never going above 100mg per day. The back specialist did a number of tests, MRI, X-Ray, and an ultrasound. Everything checked out fairly normal other than some minor degenerative arthritis in my lower back, but nothing in the area I was experiencing the continued pain. She recommended that I see a Chiropractor, and she changed my meds. She took me off the tramadol, and put me on Gabapentin, Flexeril, and Baclofen.


I stopped taking the Tramadol on a Friday, and started the new meds. I felt OK on Friday at work, nothing really of note. When I got home Friday night I felt really, really tired. Not only physically, but very mentally exhausted. Like even getting up to go get a drink or eat dinner was a task in itself. I'm married and have 2 kids under the age of 8 so laying around the house all day isn't exactly an option. That night, I woke up at 2am completely drenched in sweat. Not realizing what was going on exactly, I figured I'd maybe had a bad dream or something. I got up out of bed and went downstairs to get a glass of milk. I sat down at table and as I was drinking the milk I began to have a major panic attack. You know, the kind where you feel like you're either dying or already dead, or stuck in a dream. My heart was racing, I was sweating, trembling, the whole 9 yards. I had a couple Xanax from an old RX so I took one and within a short time I felt OK enough to go back to bed. I slept until 7am and woke up, again drenched in sweat.


That day at work, I could barely function. I was extremely grouchy, unmotivated, nervous and extremely depressed. As I was sitting at my desk being miserable, I realized that all this might be related to changing meds. Since I was feeling awful, I went out to my car and grabbed my tramadol. Took 1 50mg pill and within an hour I felt absolutely fine again. Motivated, full of energy, no depression or anxiety. I called my doctor and told the nurse that they put on the phone what was going on, and that I only had about 2 or 3 days worth of Tramadol left in my prescription. She said she'd never heard of people having that problem before, but she went ahead and called in a new script for me. That was about 2 months ago, during which I've stayed on 100mg of Tram per day, combined with taking the Gabapentin 300mg before bed as instructed by the back specialist.


Now is where the trouble really starts. I had a checkup with my primary doc and she said she wanted me get me off the Tramadol, as they don't like to keep people on it long term. I explained to her what happened with the anxiety and panic attack when I stopped taking it. She put me on Cymbalta which she said should help take care of that, and to taper down to 50mg of Tram for a week, then stop taking it. I did that, and the anxiety wasn't too bad, but the awful, crushing depression is still there. After a month, I felt like something needed to change. I called and made an appt to be seen again, and took a dose of Tram. As expected, I felt great. No anxiety, no depression, tons of energy and a great attitude. I don't ever feel "high", I just feel NORMAL, and I'm able to function at 100% and be happy. Which is rare for me. Anyway, the doctor then added Wellbutrin 150mg to the Cymbalta 60mg, which she said should take care of the depression.


I've been on the Cymbalta for a total of 7 weeks now, and the Wellbutrin for 3 weeks. The depression is still going strong. And to make that worse, I noticed now when I take a Tram to help, it does absolutely nothing. I even got bold and tried taking 200mg of the Tram in the morning, and it still did zero. So apparently there is something about Wellbutrin that blocks the effects of Tramadol so much it's worthless. Has anyone heard of this? My back specialist said she is fine writing me a script to go back on Tram, but I need to figure out wtf is going on before I waste more Tram. I'm debating just stopping both the Cymbalta and Wellbutrin as they don't seem to be doing much of anything other than making me feel a bit like a zombie and muting all my emotions, both the good and the bad. I'm also wondering how long I need to be off the Wellbutrin before my body will allow the Tramadol to work again. I stopped taking it 3 days ago, and tried 50mg of Tram this morning and it still did pretty much nothing.


Thanks guys!!
 
Part of Tramadol's effectiveness in pain management comes from the fact that it isn't just a mild opioid, but also an SNRI, i.e. an antidepressant (it is structurally similar to Effexor), so getting off Tram means you're not just experiecing opioid withdrawal but also antidepressant cessation symptoms. Technically the Cymbalta should have taken care of the latter though... maybe you're not getting enough serotonin? While Cymbalta and Effexor are both SNRIs, Effexor tends to be more selective for serotonin. Another part of the problem is that after taking Tramadol for a long time, you might simply have developed a certain psychological dependence on the opioid effect (not judging or anything, just saying it is likely part of the equation).

As for Tram no longer working while being on Cymbalta and Wellbutrin - both of these drugs inhibit a liver enzyme called CYP2D6, which normally converts Tramadol to O-DesmethylTramadol. O-DSMT is more potent than Tramadol as an opioid and still inhibits norepinephrine reuptake, but doesn't affect serotonin, so if a lack of O-DSMT ruins the Tramadol experience for you even though the Cymbalta and Wellbutrin are both keeping your norepinephrine levels elevated, then chances are your brain is still pining for that opioid effect.
 
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