Can tramadol induce hypomania?


There are case reports of tramadol induced mood changes. ( e.g.: Tramadol-induced mania, B Vince Watts;Grady, Tana A,The American Journal of Psychiatry; Nov 1997; 154, 11 ).Tramadol is a centrally acting analgesic.It is a mu agonist. It inhibits reuptake of norepinephrine, serotonin and enhances serotonin release. It is molecularly similar to Venlafaxine.

Importance to psychiatrists: 1.  Increased risk of seizures with SSRI, TCA. 2. Reduce seizure threshold, hence caution while prescribing to individuals with epilepsy.3. Increased risk of serotonin syndrome with mirtazapine, SSRI and MAOI and venlafaxine.  3. Tramadol use can lead to dependence with withdrawal symptoms. 4.Tramadol can induce mood changes (e.g.: euphoria). 4.Tramadol can cause respiratory depression , hence caution essential while prescribing other medications with similar effect ( benzodiazepines) to patients who are at risk of overdose.

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