Does tramadol work for anxiety?

Anxiety disorders are the most prevalent mental health concern in America, affecting an estimated 40 million American adults. In fact, 31.1% of adults in the United States will experience an anxiety disorder during their lifetime. To treat anxiety disorders, doctors may prescribe an anti-anxiety medication, such as a benzodiazepine, or an antidepressant (including SSRIs, SNRIs, or tricyclic antidepressants). Sometimes, a combination of medications may be prescribed.

According to data published in the Express Scripts State of Mind Report, 11.1% of the population was taking an antidepressant in 2019, and 4.9% were taking anti-anxiety medication. And almost 50% of individuals taking an anti-anxiety medication also took an antidepressant.

Sometimes, the pain medication tramadol is prescribed to manage symptoms of anxiety. As an opioid, the drug works with opioid receptors in the brain to release dopamine, a chemical that can make you feel relaxed. But does tramadol help with anxiety? Here’s what you need to know about tramadol for anxiet

What is tramadol (Ultram)?

Doctors who prescribe tramadol for anxiety are using the drug off-label. That means the drug is approved by the FDA for something other than what it’s being prescribed to treat. In this case, Tramadol is an opioid medication that is FDA approved to treat moderate to moderately severe pain. According to Wendi D Jones, Pharm.D., a pharmacist with AspenRx Health, off-label tramadol is used for the temporary treatment of premature ejaculation in males, restless leg syndrome, anxiety, and depression.

But tramadol is a class IV controlled substance that can be habit-forming, especially with prolonged use.

Tramadol for anxiety

In addition to the pain-relieving effects of tramadol (caused by its action on opioid receptors in the brain and spine), tramadol inhibits norepinephrine and serotonin uptake similar to some SNRIs, Dr. Jones says. “Low-dose tramadol has been shown to be generally safe, effective, and fast-acting for depression,” Dr. Jones says. And case studies show that some patients who are prescribed tramadol experience an improved mood.

Some physicians might prescribe tramadol for anxiety and depression. The drug works quickly, and patients using tramadol for anxiety or depression often feel better with the first dose, Dr. Jones says. Although onset and duration are not well documented when it comes to anxiety and depression symptom relief, Dr. Jones says that tramadol is rapidly absorbed, with peak concentration occurring within two to three hours. 

“Pain relief is usually experienced within one hour of taking the medication and can last four to six hours after a single dose,” Dr. Jones says. “Case studies for anxiety indicate relief for multiple hours following a single low dose.

However, there is a chance of dependency with the drug when used for more than short-term use, explains Joshua Flatow, MD, medical director and chief psychiatrist at Pacific Mind Health in Long Beach, California. For this reason, some physicians may be hesitant to prescribe tramadol for anxiety alone. It may be best used for patients with concurrent anxiety and pain. 

The best option to treat anxiety depends on the patient, Dr. Flatow says. That’s because an individual’s medical history and comorbidities come into play. But as much as possible, Dr. Flatow advises his patients to do therapies like cognitive behavioral therapy (CBT), a research-backed anxiety treatment, along with any medication they are prescribed. 

Tramadol side effects

The following are some common side effects of tramadol: 

• Dizziness
• Constipation
• Sleepiness
• Headache
• Nervousness
• Dry mouth
• Agitation
• Tremors
• Muscle tightness
• Heartburn and indigestion

More serious side effects include:

• Seizures
• Allergic reactions
• Serotonin syndrome
• Increased suicide risk
• Respiratory depression 

It’s important to note that tramadol can increase the risk of serotonin syndrome, Dr. Jones says. This occurs when multiple medicines affect the serotonin reuptake receptors, causing a marked increase in serotonin in the body, she explains. “Symptoms include shivering, diarrhea, restlessness, elevated heart rate and blood pressure, muscle rigidity, sweating, hallucinations, and more,” Dr. Jones says, adding that serotonin syndrome is a medical emergency that can progress to high fever, unconsciousness, coma, and death. 

Because there are multiple medications and herbal supplements that can affect your serotonin levels, always be sure to speak with your pharmacist before you start something new, Dr. Jones recommends.

Who should not take tramadol for anxiety?

The drug is contraindicated in patients with the following characteristics, Dr. Jones says:

• Hypersensitive to opioids or have a history of opioid abuse 
• History of suicidal behavior or ideation
• Severe asthma or other respiratory diseases
• GI obstruction
• Senior patients
• Children younger than 12
• Adolescents younger than 18 who have had a tonsillectomy or adenoidectomy
• Pregnant or breastfeeding women

Additionally, people taking the following medications and supplements may need to avoid tramadol:

• Monoamine oxidase inhibitors (MAOIs), such as phenelzine, selegiline, and isocarboxazid
• Tricyclic antidepressants (TCAs), such as doxepin, amitriptyline, and imipramine
• Selective serotonin reuptake inhibitors (SSRIs), such as escitalopram, fluoxetine, and paroxetine
• Triptans, such as eletriptan, almotriptan, and sumatriptan
• Benzodiazepines, such as diazepam, lorazepam, or alprazolam
• Drugs with central nervous system (CNS) depressant effects, such as cyclobenzaprine and diphenhydramine
• Certain antifungal medications, such as ketoconazole
• Certain antibiotics, such as erythromycin and rifampin
• Certain antiviral drugs, such as ritonavir
• St. John’s wort 
• Alcohol

Tramadol can also interact with grapefruit juice. Consult with your provider or pharmacist about dietary changes you should make when taking tramadol.

Tramadol dosages for anxiety

Prescribers should start with a low dose and make any dosage changes slowly, Dr. Jones says, adding that effective dosages for anxiety/depression are lower than those needed to treat pain. “Typically, patients begin with 50 mg,” Dr. Jones says. “The immediate release tablet can be cut in half. If necessary, the prescriber may choose to start lower than 50 mg. It is always recommended to start at the lowest possible dose for the patient and then increase the dose slowly until the patient’s symptoms are well-managed.

A patient’s age, weight, and kidney function can affect the dose that’s necessary to manage symptoms, Dr. Jones says, and genetics can strongly affect sensitivity to tramadol. Case studies indicate that the medication works within an hour, lasting up to six hours.

How much does tramadol cost?

Generic tramadol works the same as the brand-name version, and generic prescriptions come with a lower medication cost. On average, tramadol costs $31 for 30, 50 mg tablets without insurance, while its brand-name counterpart Ultram averages $142 for the same dosage and quantity. The brand-name, extended-release version of tramadol, Conzip, costs an average of $342 for 30, 100 mg capsules. A SingleCare prescription discount card can lower the generic medication price to less than $10. It also works for refills and other prescriptions.