Anxiety from Tramadol taken with Oxycontin and SSRI'S and Tricyclic ant-depressants

[shugalug]

I was put on tramdadol SR,150mg  to take with 50mg faster acting tramadol. I have chronic arthritis pain. I also take 30mg oxycontin, 2 endone(oxycodone hydrochloride, 30mg mirtazapine and 10mg zoloft. I am also on Gabapentin, 600mg X 3, daily for phantom limb pain due to amputation of right leg. Since starting tramadol, I have been feeling jittery and very anxious, fearful for no reason,  and now depression has set in rather bad. I started weaning down the tramadol after 4 days as that was the only different thing I was doing and thought it must be that, upseeting the balance of neurotransmitters in my brain. I feel I'm getting a bit too much serotonin now. I was 'normal' and happy before starting tramadol. I had a terrible experience with extreme anxiety for over 6 mths, last year, resulting in deep dark depression. I soon fixed it myself, as all the different meds the psychiatrists tried me with, only made me worse with nausea added to the mix Weaned off all those before I got too addicted, and began taking gabapentin again, which solved the whole problem. I had stopped taking the Gabapentin suddenly, as I didn't have the money for it., and that is what caused the anxiety/depression. Now that  is, or was under control, I cannot bear to feel this anxiety jitters and strange scared feeling again! Can you advise?Thank you.

[shugalug]

Thanks so much for replying and your advice. Yes, I know about Serotonin Syndrome and had experienced the beginnings of it last year when I was prescribed Pristiq, then Lexapro, and finally Seroquel, which really put me over the edge. I weaned myself off the lot, as I was so ill, mentally and then physically. All this was prescribed on top of 60mg Mirtazapine. I tried to get my GP to have me put in hospital, as I did think I was having Serotonin Syndrome, as I was vomiting, couldn't eat, and was skin and bone and dying I reckon. All this was over a period of 6 and a half months, until I finally took a gabapentin capsule for severe phantom limb pain, one day, and it fixed or balanced my neurotransmitters, and I felt normal again after all that horror. Was OK mentally, until Tramadol was prescribed 3 weeks ago. I started weaning off too fast, after the first 4 days, as I felt strange and the anxiety began again. Today I have upped it another 25mg, but not taking the 450mg I was prescribed, but taking only 400mg. In 4 days I'll cut down another 50mg and so on, till I'm off it. I'm still on Mirtazapine 30mg X 2 daily, 25mg Zoloft (not 10mg like I first thought), even though I'm prescribed 50mg of that too, but felt the anxiety with that dose, so cut it by half. I told my  Psych, and she frowned upon it, but said if I was more comfortable with the lower dose, to keep it that way. My Gabapentin has been upped to 600mg 3 X daily, because of Phantom Limb Pain getting worse (because of pinched nerves from arthritis, too much to explain). I did not know, until recently, that Tramadol also has anti-depressant properties. My GP should not have prescribed it. If I had known, I would not have taken it at all. I am well aware, too, of the foolishness of my having started abusing the sleep med Imovane (zopiclone), by taking twice the amount and then another 1/2. That has only been for 3 nights, so will stop that before I create worse problems for myself. I was just feeling so shaky and full of fear for no reason, that in desperation, I turned to that. I am a recovered alcoholic, 4 years sober, so I know I have an addictive personality. I'm also dealing with valium addiciton, so trying to wean off that too. I do need help and advice, and that's why I joined this forum, as my GP and Psychiatrist are not helping, but rather they are hindering my progress. I was referred to the Psychiatrist to sort out my meds, and start weaning me off valium, but instead, she just prescribed  Seroquel, now Zoloft, and has kept me on valium. My GP is also prescribing me valium. I assumed, and was told by my Psychiatrist, that she is reporting my progress to my GP, that they both know they are both prescribing valium 2 a day by each, making it 4 a day. I've tried to take less most days, none on other days, and then 6-10 on yet another day. I am doing it all wrong, I know. I even told my Psych that is the way I take the valium, and she said to do it that way, if that is keeping me even and balanced, but just not to go more than 4 days without taking at least 1, because of the half-life of valium, which stays in the body for about that long, or something like that. So I've been merrily going along, doing it all wrong, and paying the consequences now that Tramadol has been added to the mix. HELP! I am up and down like a bride's nightie, all day, experiencing a huge array of extreme emotions. I'm trying to stay positive, but one minute I'm ok (sort of) then the next breath, I feel like ODing and be done with it all, but know that's not the answer, and might not even work and I could be left brain damaged, kidney failure, liver damage etc, so NO, of course I can't do anything like that. I don't want to, as I still have some hope left in me. Sorry for the long reply to your post, nursegirl6572, and thanks again for reminding me about Serotonin Syndrome and addiction caused by abusing medication.

[shugalug]

Sorry to have confused you. I'm confused myself! Before stopping gabapentin suddenly last March, I was having to pay full price for it. That was one of the reasons I wanted to stop. My amputee doc said it was ok to just stop taking it without weaning, as it's supposed to be a non-addictive drug. After a week of being off it, that's when this panic attack hit me, and anxiety, jitters, all that horror set in and depression, deepest, darkest, most awful despair, followed. My GP referred me to a psych who put me on pristiq. God, was I sick from that and it did nothing to ease my symptoms and just added nausea to deal with. He was a nsasty piece of work, really looking down his nose at me. Anyway, I refused to go back to him, so she prescribed Lexapro. That was nearly as bad, so weaned off that. She sent me to an other psych, who prescribed Seroquel. Now that was a doozy! That made me even worse. That would have to be the most dangerous psychotic producing drug there ever was! I weaned myself off them, and just felt like dying, as nothing was helping. One day, my phantom limb pain was really attacking me. I had some gabapentin left, and in desperation, took 1. It helped settle the electric like volts of pain shooting thorugh missing leg and foot, and also, within 2 hours, I suddenly realized I actually felt 'normal' for the first time in nearly 7 months. I wondered if it was taking the gabapentin that did it. I didn't have any the next day, and sure enough, anxiety/depression was there again. The day after, I decided to try another gabapentin to see if it was just a coincidence or if it would really relieve my anxiety. It did!  From then on, I took 1 a day for 4 days and had my appt with the psych. I told her and she said to keep taking it, as sometimes, gabapentin is prescribed as an 'offf-label' use for anxiety/depression. It was worth the money, but it was a squeeze. I had an appt to see my amputee doctor, the one who said to just stop taking it suddenly, and told him what had happened and why I hadn't been able to keep my appt with him 5 months earlier, due to the anxiety and could not even go out of the house. He was extremely upset at what he'd done, and kept apologising. He made a note of it, to warn other patients who were on it, to wean off and not stop it suddenly. Anyway, he kindly arranged for me to get the script there, at the hospital, at the pensioner rate, as I am on a Veterans Affairs pension. I had gotten my confidence back, was assertive, happy normal, until being prescribed and taking Tramadol 3 weeks ago. A living hell again ever since. I've learned that I was cutting down too fast, so have upped it a little, and will cut down by 50mg a day for 4 days, then another 50mg for 4 days and so on, until I'm completely off it. Other meds have to e sorted out next, but one thing at a time. Valium withdrawal is the next. Good Lord! I'll be going the alternative medicine way after all this. I am an addictive personality, and recovered alcoholic, 4 years sober, and really should not have been prescribed these drugs, as it cautions on the leaflets that come with them, that they should not be prescribed for persons who have had an addiction problem in the past, or at least, they should be carefully monitored. My list of meds is endless! What have I gotten myself into?I can't entirely blame the doctors, as I am the one who takes these meds and should know better, myself. Thanks for listening, Paxiled

[nursegirl6572]

Well, Tramadol acts on the same receptors as opiates do, also, it is very similar to SNRI antidepressants, like Effexor, in how it acts on the brain.

When taken for long enough periods of time, if stopped abruptly, it will absolutely cause significant withdrawal symptoms, both physical and emotional....identical to opiate w/ds, only with a much more severe emotional aspect of w/ds, due to its antidepressant properties.  Because of thre above, Tramadol must be slowly tapered iff, to avoid withdrawal symptoms.

Taking Tramadol along with an SSRI or SNRI is contraindicated, as there are staggering numbers of reports of serotonin syndrome occuring among patients who are on an antidepressant and tramadol.

You say there is another med you are absuing.  If you are abusing your meds, you've got a whole other issue that needs dealt with.  Addiction will spiral out of control quickly, and tramadol is a very commonly abused drug.  If you have addictive tendencies, I would strongly recommend steering clear of it all together, even if you weren't on an antidepressant.

Best to you!!

[shugalug]

Thanks so much for replying and your empathy. I replied to remar, and explained a bit further about what I'm taking, what I'm trying to wean off, and more medication problems. My amputee doctor kindly arranged for me to get my script filled for the pensioner rate, at the hospital where I go for follow up consult on my amputation. I had relief from anxiety/depression for few months, until starting Tramdol 3 weeks ago. It worked pretty good for my arthritis pain, for 4 days, but I felt rather weird on it, and started feeling the anxiety returning. That gave such a fright, as I NEVER want to go through that hell ever again. My GP had said if I start feeling 'off' to just stop taking it. I will NEVER just stop taking a med suddenly ever again, after my experience in stopping gabapentin suddenly. She knows this, and I'm disappointed in her for saying to just stop the Tramadol, just like that. I started cutting down too much, and that's why anxiety set in full bore. I've since learned, through a friend, who has had the same experience with Tramadol, that I should only cut down by 50mg a day for 4 days, and so on till I'm completely off it. Being on 2 different anti-depressants is ridiculous too, I feel, as  they are upsetting the neurotransmitters balance, and it would seem I am getting too much Serotonin, especially with Tramadol added to the mix. Gabapentin had balanced my neurotramsmitters, now Tramadol has upset the balance again. Also withdrawing from valium, as I've had to cut down to 1 5mg instead of the 4, 5mg I was on a day. My psychiatrist said she posted a script out to me on the 13th of March. I have not received it yet, and of course she won't write another script. That's understandable, as she doesn't really know me, and I could be lying for all she know. I am not, I can assure you. So, to get around that problem means I have to take less, so they will last until 10th April, when my next appt is with her. Also to help me cope, I am stupidly starting to take yet another med, prescribed for sleeping, which I hardly ever took before all this, as I didn't to get addicted, but am now taking more than double the amount prescribed, in the evening, as I cannot handle the jitters I've been feeling all day, any longer. I know I'm a fool to do this, and only creating another problem I'll have to deal with, but... Anyway, I'll get through this somehow and this nightmare will be behind me, yet again! After all this, I'm going the natural way, thank you. Physical pain is bad enough, but mental anguish and despair is sheer torture!

[shugalug]

Yes, it WAS the cause of my anxiety bout last year, as I had stopped it suddenly, due to cost. I put myself back on it when my phantom limb pain was extremely jumping one day, and as I had some gabapentin left, I took 1. That's when I realized that it got rid of my anxiety and therefore, my depression lifted as I was so glad to feel 'normal' again. I continued taking 1, 300mg gabapentin for 4 days and theanxiety did not recur, and I felt better with each day. I saw my psychiatrist and told her. She said it's often used as an off-label for anxiety/depression and to keep taking it. I had been OK for a few months, mentally, even if not physically, but I was quite happy again. I was put on Tramadol 3 weeks ago, as an adjunt to my other pain meds, to help relieve arthritis pain. It worked for 4 days, but I started feeling a little weird, so got a fright and decided to wean myself off it. My doctor had told me to just stop taking it if I start feeling anxious. I will NEVER ever again just stop taking a med without weaning. I cut down too fast. This caused great anxiety to hit me again, with depression starting too. I have since learned I should only cut down by 50mg a day for 4 days, then another 50mg for 4 day and so on, until I'm not taking any. So, today, I'm doing it the right way, and don't feel too bad at the moment. I'm also having problems with valium, but that's a whole other issue I have to deal with (withdrawal, as I'm nearly out, and my psych said she mailed me a script, which I have not received yet, so have to take less than prescribed, so as I won't be left with none at all, until my next script is due). Crikey, it's a lot to cope with, and withdrawal is a horrifying experience! So all that on top of the Tramadol weaning is nearly unbearable, but the body goes on , unfortunately, and we have to get through somehow. I have another med, which I am now abusing, to help me cope, and I know that's creating yet another problem I'll have to deal with. Doctors do not hear me, and just don't care or understand. My doctor and psychiatrist, at least, do NOT care. They just want the money. I could go on, but won't. That's enough for now. I'll just say that the medication I am now taking more of than prescribed, is a sleeping med called Imovane (zopiclone). By evening, I am in such a jittery nervous wreck state, that I have to have it by 7ish, then that doesn't work, so take another about 8ish. Then another 1/2, till finally I am feeling calm. This is horrible. I am in a right mess with medications, and wish I'd never gone along with what these supposed 'Healthcare' experts prescribed. I'd rather have the physical pain any day, rather than mental anguish. I will get it sorted somehow.

[Paxiled]

Gabapentin is generic and quite inexpensive, so I'm also a bit confused here -- your other meds should be more expensive.  It can't be more expensive than tramadol, since it's an old drug and has been generic for some time now.  Are we all confused?

[RubyWitch]

After reading remars reply, I see where I may have misunderstood about the sequence of you taking Gabapentin. If it helped you before but you can now no longer afford it, remar is right that many pharmaceutical companies have patient assistant programs for their more expensive meds. Also, as he said, most doctors have the necessary paperwork for these programs at their offices, or can tell you how to get them.
I apologize for any misundestanding on my part.
GL

[RubyWitch]

I'm afraid I'm confused as to exactly what you're taking right now and what you've taken yourself off of......

Last year when you had your terrible bout of anxiety and depression, was the doctor aware and helping you withdraw from the medication he had put you on? You stated, "I soon fixed it myself as all the different meds the psychiatrists tried me with, only made me worse with nausea added to the mix Weaned off all those before I got too addicted, and began taking gabapentin again, which solved the whole problem." It makes me a little nervous to think you are making these changes without consulting the doctor. Messing about on our own with dosages or withdrawing can create far worse problems than what we were taking the medication for in the first place.  

Am I correct in thinking you've gone off the tranadol? And am I correct in thinking you were only on it for 4 days? If that IS the case, you would not have to "wean" yourself off after that short of time, and it shouldn't be the cause of your anxiety, jitters and scared feeling.
I also don't understand the 10mg of Zoloft. I've never heard of anyone taking that small of a dose, even as an adjunct to another antidepressant.

I would STRONGLY urge you to sit down with your doctor and go over your medications and together decide where you should go from here.
I wish you the best.
Peace
Greenlydia

[remar]

I'm so sorry you're going through this. Anxiety is awful. Yours could be caused by stopping the Gabapenlin suddenly. I really can't say for sure though. I would recommendtalking to our Dr about a med program. It's for people that can not afford their meds. He/she may have the forms right in their office for you to fill out. Or, they may have you contact the company that makes your med