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Summary: Since chronic pain syndromes and depression simultaneously occur in many patients, it is likely that tramadol and an SSRI will be used together. However, concomitant use of these drugs is known to increase the risk for seizures and serotonin syndrome (see the figure below).
According to the prescribing information, Ultram should not be given to patients who are addiction-prone or suicidal. Furthermore, Ultram should be used with caution in patients concomitantly taking tranquilizers, antidepressants, use alcohol in excess or who have been diagnosed with emotional disturbance or depression. Ultram related deaths have occurred in these populations of patients. Serotonin syndrome is possible with treatment with Ultram alone.
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