Posted by bleauberry on September 9, 2009, at 10:02:43
In reply to tramadol and increased desire to smoke PLEASE, posted by sam K on September 8, 2009, at 23:31:02
Your experience thus far is fairly inline with what others have said at med-rating forums. Some people do horrible on Tramadol, but it seems that in the depression category of people it has marked potential. Oddly, most people who did well with it were started on it for post-op pain or something like that, and were taken by surprise to see their longstanding depression vanish.
The addiction and tolerance thing however is real. It is early in the game for you. People suffer horrible withdrawals even after just a couple weeks on Tramadol. Tolerance for most people does happen. For some, they let it get out of control and they keep ramping it up to absurd levels. Others find a pateau and stay there and do well. Others take weekend holidays from the drug.
Self discipline and management is a key requirement for treating depression with Tramadol. Because you have to mentally accept that you are dependent on the drug to avoid hard withdrawals. And because the temptation to keep increasing the dose can lead to real problems.
I do not believe there is another opioid you could consider as a substitute. That's because much of Tramadol's antidepressant function comes via serotonin reuptake and norepinephrine reuptake, probably with unknown actions on dopamine since dopamine is tied to opioids, and add into the mix some opioid mechanism, and well, there just isn't anything else that does all that. Some claim it is the SNRI function of Tramadol doing the work. But if so, it must be somehow distinctly different than how other SNRIs interact at the receptors. Because it usually kicks in fast, like days, unlike other ADs. No doubt the weak opioid function is playing a role, but it is said to be weak compared to its SNRI function.
As for the smoking, I don't know what to tell you. Nicorette gum is obviously a better option than smoke. They have two good flavors I like. Cinnamon, and Fruit Chill. The unflavored stuff is kind of yucky I think. I don't like any of the generics either.
poster:bleauberry
thread:916149
URL: http://www.dr-bob.org/babble/20090902/msgs/916177.html