It’s customary to say something along the lines that tramadol is one of the most effective painkillers on the market and then stop. But the relationship between pain and depression is complicated and, in many cases, it’s difficult to have the one without the other. People who are injured or develop painful diseases or disorders, can and do become depressed. When they take a painkiller, the pain reduces and they feel less depressed. Even though the label on the box may say that tramadol is for the relief of pain, there’s no doubt that it can affect the way people see the world.
One of the reasons why there’s an overlap in effect is because tramadol affects the level of serotonin in the brain. Some of the antidepressants work in the same way. Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin and Norephinephrine Reuptake Inhibitors (SNRIs) are two of the major classes of drugs used to treat depression and the only difference between an SSRI or SNRI and tramadol is the degree of the effect on the serotonin level. Indeed, both types of drug produce similar serotonin-based withdrawal symptoms when people stop taking them.
However, there has been little formal research into whether tramadol should be licensed as a treatment for anxiety disorders and depression. There are two quite different reasons for this. There’s some prejudice that opiates should not be used to treat people whose mental state is vulnerable. The argument runs that tramadol can be addictive and this would add further injury to those who are already ill. In reality, SSRIs and SNRIs cause just as many problems as tramadol. The second reason is economic. As it stands, tramadol is now out of patent protection and it’s sold as a generic for relatively low prices. The majority of the antidepressants are still within patent protection and so command significantly higher prices and make more profit for the manufacturers. Since the pharmaceutical industry funds many of the clinical trials, it’s unlikely to pay researchers to prove that cheap tramadol is just as effective as profitable antidepressants.
As it stands, the balance of medical opinion does not support the use of tramadol for anxiety and depressive disorders alone. The FDA and other regulatory bodies have not been asked to approve this use. Indeed, until there is formal research to support approval, the FDA will not license its use for this purpose. This leaves tramadol in a curious situation. There’s little doubt that people who are in pain and also depressed, find the drug effective in relieving both conditions. But, for now, most doctors will not prescribe it for anxiety and depression alone. Given the general rule that it’s a bad idea to self-medicate, you should not simply buy tramadol from an internet pharmacy and use it to relieve anxiety and depression. Discuss the issue with your doctor before taking any decision.