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tramond -- off Remeron and Effexor

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I have been asking for melatonin!

It is not allowed in switzerland(But Psychatric drugs you can have as mutch as you want!!!


I think so as well, Alto.................I need sleep but it is to creazy

he night before this night I did not sleep at all! The last night I slept 4 a half hours!

It seems I just get the sleep with I need to survive!!


Lovely greetings



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Hoi all!

Since weeks I do have this creazy akes and pain witch I try to describe!


It is mixture out off pain, draggind , sharp and dull pain! In the nek, the head, the ears and sometimes in the teeth as well!!

Sometimes it is permanent in the fronthead, under the eyes, than gives me sharps somewhere in the head............. Than it is oveing around in seconds all over in my head!


Yesterday for example, the pain was constant in the neck and back head......................Today neck and backhead are painfree but the pain is moveing, dragging in the left ear, the left teath the left front head and nose bone...........a sharp in the head(not even a second)a sharp in the teeth............moveing and moveing.............like flaming up for not even a second in every part of my head!!!


I did have an accident 3 month ago and got a whiplash!

In my oppinion this kind of akes started 2 or 3 weeks after that! I had similar pains before but I can not remmber exactly howe they have been, witch quality it was!!

As well I feel pain in my feet sometimes in my ankles of the hands................for a second in a finger and and and................As well I found out during the last weeks that my feet and hands have gone dead verry often¨¨¨!!

I am totaly without energy............and I dont know annymore is it WD or are this akes from the whisplash............because if I do research for whisplash they describe the symptoms and pain verry similar!

As well other symptoms I have are so similar...like I get slower and slower in my thinking and doing..........I can not remeber easy things.my cognitive behaivour is getting less every single day! I need 5 minutes to remember what have I done yesterday!! I am totally leasy.........because there is no power for nothing!!!....and depression without an end!


I really dont know is it wd is it because of the whiplash..is it both????


Is there someone with similar experiences?

YOur oppinions or experiences would be verry appriciated!!


Lovely greets



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Sorry I forgot!!

Sometimes the pain is in my legmuscles as well........just for a second to disapear come and go again!!

Ibuprofen and diclofenac do not help at all!!!

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HI Tramond,


OOhg yes i can associate so well, i have the same pain, mainly in back of head/neck/shoulder area left hand side,

also down front of legs and lower back area, the lower back pain started after my first ct attempt off Paxil, the

rest of it has flared up in my 2nd attempt at slow tapering off.


Have seen so many doctors for what its worth lol, and they all diagnose muscle pain = tension,

Personally i believe its to do with antidepressants, as it seems to be common knowledge that

serotonin gets stored in the gut area and often gets trapped in the muscles, and as wd is so

understandably stressful i can absolutely understand why we would suffer with tightness and tenseness

which would account for the many aches and pains most wd sufferers complain of.

Im sure as our bodies adapt and serotonin is created naturally that this will go away,

thats my theory anyway and my hope for a future after paxil that is pain free.

My hope for now is that it helps you realise thaT YOU ARE SO NOT ALONE, miserable and painful as it is,

but so normal for all of us unfortunately.

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I think the EU is too restrictive about supplements. Can you get it through mail order?


tramond, that is a very familiar pattern. It does get better, but it can take months.

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Switzerland is not a member of the EU!

We just wash the money for them!!

Imagine.......howe mad the state I live!

The doctors offered me Tramadolor and CodicontynCodein-Morphin) against my pain. I easely could get on Morphin but Melatonin is not allowed in here!!!!!!!!!!!

Switzerland is full of the Pharma-Lobba! every pharmaconcern has his seat in switzerland and giving his advice to the goverment!!


We wash money................we wash brains!!!!!

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That made me laugh, tramond.

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Great Alto...................that I made you laughing :-))

Better than always in worry about me!!!!!


Thanks for everything!!

Lovely greets



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I am desperate!!


My akes and pain in the head and ears and teeth and and and.....are constant and more every day!

I do have a whipslash and did not want to believe that the pain is from that, because my pain of wd was similar!!I did research and found out my pain is typical for whipslash and I do think my serotoninchaos makes it even worst!


Pain everyday!!!

I am desperate and verry sad!

have benn fighting against the benzo and die win...........fighting against the ADS since 22 month.......strong and powerfull..jjust to get one on my head!!


I have been at the physio, craneosacral ostheopath, neurolog and................NOTHING helps me!!!


I see myselfe ending up full of morphin and after some years........getting in to a psychatric clinic because my brain is mus and mad destroied at least from morphin!!!


I dont understand it annymore!!!

Thik and tired of fighting!!



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Hoi Angie.we share some symptoms!

The thing is, i dont know annymore what is it from!!


My cervical vertreba is really injure because of the accident! The ostheopath said it is relly smashed in the way I got hidden!

My pain now is so strange and every minite I dont know where is it from! It is neuralgic pain...moveing through my head.............mostly in the ear right side and the eye and the headside....than it is moveing allover in and on my head! And it flares up like a little hit a slash on different places in my head!!


Sometimes my nerves seem to be so sensitiv that using my glasses is hurting!!

As well the teeth, the neck........every part of my head is involved!!!


I have had a similar experience last year....just a few weeks offf...my left face and head was aking! Druging pain in all my left part of the head and face! Ear, eye nose, teeth everything was in this neurological draging pain!! In this time I was sure it was wd related......but know I dont know annymore!!!


Could be because serotonin is verry invoved in the way we feel pain, is the reason that I do feel, have this kind of pain!!!!


Anny experiences..........would be verry appriciated!

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The last days there are new pain growing up!!


pain in my arms and hands and handankles!! Moveing like the others!!


And pain in the front of my tigh! both sides!!

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Hey Tramond,


I really seems that most of your problems stem from the withdrawl and not from the accident. I also have problems with my neck from the pills.

I somewhere read that your pains diminished for a while after the accident. I guess this would not be the case if it wasn't from wd.

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Hoi all!


I suffer apin witch I dont know annymore what is it related to! Thought because of my accident(Read more under symptoms)!

So the doctors (doc, psych) told me after month of pain I have to take painkillers otherwise the pain will get independent with his own dynamik!

Ok.......................My doctor knows I have wd syndrom from effexor and told me I should take Tramal!


IDID.............yesterday evening I took it the first time and...........got this itches allover my body!!!

Did profound research about Tramal and look what is the outcome!!!


UNBELIEVABLE what kind of stupid mad people are licensed to be a doctor!!


Greets to all





From Wikipedia, the free encyclopedia


Systematic (IUPAC) name

(1R,2R)-rel-2-[(dimethylamino)methyl]- 1-(3-methoxyphenyl)cyclohexanol

Clinical data

Pregnancy cat. C(AU) C(US)

Legal status Prescription Only (S4) (AU) POM (UK) ℞-only (US) ℞ Prescription only

Routes oral, IV, IM, rectal, sublingual, buccal, intranasal

Pharmacokinetic data

Bioavailability 68–72%(Increases with repeat dosing.)

Protein binding 20%

Metabolism Hepatic demethylation and glucuronidation

Half-life 5.5–7 hours

Excretion Renal


CAS number 27203-92-5

ATC code N02AX02

PubChem CID 33741

DrugBank APRD00028

ChemSpider 31105 Yes


KEGG D08623


Chemical data

Formula C16H25NO2

Mol. mass 263.4 g/mol

SMILES eMolecules & PubChem


(what is this?) (verify)


Tramadol hydrochloride (Ultram, Tramal) is a centrally acting opioid analgesic, used in treating moderate to severe pain. The drug has a wide range of applications, including treatment for restless leg syndrome and fibromyalgia. It was developed by the pharmaceutical company Grünenthal GmbH in the late 1970s.[1][2]


Tramadol possesses weak agonist actions at the μ-opioid receptor, releases serotonin, and inhibits the reuptake of norepinephrine.[3][4]


Tramadol is a synthetic analog of the phenanthrene alkaloid codeine and, as such, is an opioid and also a prodrug (codeine is metabolized to morphine, tramadol is converted to O-desmethyltramadol). Opioids are chemical compounds which act upon one or more of the human opiate receptors. The euphoria and respiratory depression are mainly caused by the μ1 and μ2 receptors; the addictive nature of the drug is due to these effects as well as its serotonergic/noradrenergic effects[citation needed] . The opioid agonistic effect of tramadol and its major metabolite(s) are almost exclusively mediated by the substance's action at the μ-opioid receptor. This characteristic distinguishes tramadol from many other substances (including morphine) of the opioid drug class, which generally do not possess tramadol's degree of subtype selectivity.




1 Medical uses

1.1 Availability and usage

1.2 Investigational uses

1.3 Pregnancy and breastfeeding

2 Adverse effects

2.1 Physical dependence and withdrawal

2.2 Psychological dependence and recreational use

2.3 Detection in biological fluids

3 Mechanism of action

4 Chemistry

4.1 Characteristics

4.2 Comparison with related substances

4.3 Synthesis and stereoisomerism

5 Metabolism

6 Legal status

7 Proprietary preparations

8 Veterinary medicine

9 Notes

10 External links


[edit] Medical uses


Tramadol is used similarly to codeine, to treat moderate to moderately severe pain.[5] Tramadol is somewhat pharmacologically similar to levorphanol (albeit with much lower μ-agonism), as both opioids are also NMDA-antagonists which also have SNRI activity (other such opioids to do the same are dextropropoxyphene (Darvon) & M1-like molecule tapentadol (Nucynta, a new synthetic atypical opioid made to mimic the agonistic properties of tramadol's metabolite, M1(O-Desmethyltramadol). Tramadol is also molecularly similar to venlafaxine (Effexor) and has similar SNRI effects, with antinociceptive effects also observed. It has been suggested that tramadol could be effective for alleviating symptoms of depression, anxiety, and phobias[6] because of its action on the noradrenergic and serotonergic systems, such as its "atypical" opioid activity.[7] However, health professionals have not endorsed its use for these disorders,[8][9] claiming it may be used as a unique treatment (only when other treatments failed), and must be used under the control of a psychiatrist.[10][11]


In May 2009, the United States Food and Drug Administration issued a Warning Letter to Johnson & Johnson, alleging that a promotional website commissioned by the manufacturer had "overstated the efficacy" of the drug, and "minimized the serious risks".[12] The company which produced it, the German pharmaceutical company Grünenthal GmbH, were the ones alleged to be guilty of "minimizing" the addictive nature and proposed efficacy of the drug, although it showed little abuse liability in preliminary tests. The 2010 Physicians Desk Reference contains several warnings from the manufacturer, which were not present in prior years. The warnings include more compelling language regarding the addictive potential of tramadol, the possibility of difficulty breathing while on the medication, a new list of more serious side effects, and a notice that tramadol is not to be used in place of opiate medications for addicts. Tramadol is also not to be used in efforts to wean addict patients from opiate drugs, nor to be used to manage long-term opiate addiction.

[edit] Availability and usage


Tramadol is classified as a central nervous system drug usually marketed as the hydrochloride salt (tramadol hydrochloride); the tartrate is seen on rare occasions, and rarely (in the US at least) tramadol is available for both injection (intravenous and/or intramuscular) and oral administration. The most well known dosing unit is the 50 mg generic tablet made by several manufacturers. It is also commonly available in conjunction with APAP (Paracetamol, Acetaminophen) as Ultracet, in the form of a smaller dose of 37.5 mg tramadol and 325 mg of APAP. The solutions suitable for injection are used in patient-controlled analgesia pumps under some circumstances, either as the sole agent or along with another agent such as morphine.


Tramadol comes in many forms, including:


capsules (regular and extended release)

tablets (regular, extended release, chewable, low-residue and/or uncoated tablets that can be taken by the sublingual and buccal routes)


effervescent tablets and powders

ampules of sterile solution for SC, IM, and IV injection

preservative-free solutions for injection by the various spinal routes (epidural, intrathecal, caudal, and others)

powders for compounding

liquids both with and without alcohol for oral and sub-lingual administration, available in regular phials and bottles, dropper bottles, bottles with a pump similar to those used with liquid soap and phials with droppers built into the cap

tablets and capsules containing (acetaminophen/APAP), aspirin and other agents.


Tramadol has been experimentally used in the form of an ingredient in multi-agent topical gels, creams, and solutions for nerve pain, rectal foam, concentrated retention enema, and a skin plaster (transdermal patch) quite similar to those used with lidocaine.


Tramadol has a characteristic and unpleasant taste which is mildly bitter but much less so than morphine and codeine. Oral and sublingual drops and liquid preparations come with and without added flavoring. Its relative effectiveness via transmucosal routes (i.e. sublingual, buccal, rectal) is similar to that of codeine, and, like codeine, it is also metabolized in the liver to stronger metabolites (see below).


The maximum dosage per day is 400 mg for oral use and 600 mg for parenteral use. Certain manufacturers or formulations have lower maximum doses. For example, Ultracet (37.5 mg/325 mg tramadol/APAP tablets) is capped at 8 tablets per day (300 mg/day) due to its acetaminophen content. Ultram ER is available in 100, 200, and 300 mg/day doses and is explicitly capped at 300 mg/day as well.


Patients taking SSRIs (Prozac, Zoloft, etc.), SNRIs (Effexor, etc.), TCAs, MAOIs, or other strong opioids (oxycodone, methadone, fentanyl, morphine), as well as the elderly (> 75 years old), pediatric (< 18 years old), and those with severely reduced renal (kidney) or hepatic (liver) function should consult their doctor regarding adjusted dosing or whether to use Tramadol at all.

[edit] Investigational uses


diabetic neuropathy [13][14]

postherpetic neuralgia [15][16]

opiate withdrawal management[17][18] / antidepressant withdrawal aid (proven to be effective, especially with withdrawal from its distant relative venlafaxine (Effexor))[citation needed].

obsessive-compulsive disorder [19]

premature ejaculation [20]


[edit] Pregnancy and breastfeeding


Tramadol is in FDA pregnancy category C; animal studies have shown its use to be dangerous during pregnancy and human studies are lacking. Therefore, the drug should not be taken by women that are pregnant unless "the potential benefits outweigh the risks".[21]


Tramadol causes serious or fatal side-effects in a newborn[22] including neonatal withdrawal, if the mother uses the medication during pregnancy or labor. Use of tramadol by nursing mothers is not recommended by the manufacturer because the drug passes into breast milk.[21] However, the absolute dose excreted in milk is quite low, and tramadol is generally considered to be acceptable for use in breastfeeding mothers when absolutely necessary.[23]

[edit] Adverse effects

Probability of adverse effects[24] Effect Probability (%)

Any adverse effect 71

Drowsiness 17

Nausea 17

Dizziness 15

Constipation 11

Headache 11

Vomiting 7

Diarrhea 6

Dry Mouth 5

Fatigue 5

Indigestion 5

Seizure[25] <1

Main side effects of tramadol. Red color denotes more serious effects, requiring immediate contact with health provider.[26]


The most commonly reported adverse drug reactions are nausea, vomiting, sweating, itching and constipation. Drowsiness is reported, although it is less of an issue than for non-synthetic opioids. Patients prescribed tramadol for general pain relief with or without other agents have reported withdrawal symptoms including uncontrollable nervous tremors, muscle contracture, and 'thrashing' in bed (similar to restless leg syndrome) if weaning off the medication happens too quickly. Anxiety, 'buzzing', 'electrical shock' and other sensations may also be present, similar to those noted in Effexor withdrawal. Respiratory depression, a common side-effect of most opioids, is not clinically significant in normal doses. By itself, it can decrease the seizure threshold. When combined with SSRIs, tricyclic antidepressants, or in patients with epilepsy, the seizure threshold is further decreased. Seizures have been reported in humans receiving excessive single oral doses (700 mg) or large intravenous doses (300 mg). However, there have been several rare cases of people having grand-mal seizures at doses as low as 100–400 mg orally.[27][28][29] An Australian study found that of 97 confirmed new-onset seizures, eight were associated with tramadol, and that in the authors' First Seizure Clinic, "tramadol is the most frequently suspected cause of provoked seizures".[30] There appears to be growing evidence that Tramadol use may have serious risks in some individuals and it is contra-indicated in patients with uncontrolled epilepsy (BNF 59). Seizures caused by tramadol are most often tonic-clonic seizures, more commonly known in the past as grand mal seizures. Also when taken with SSRIs, there is an increased risk of serotonin toxicity, which can be fatal. Fewer than 1% of users have a presumed incident seizure claim after their first tramadol prescription. Risk of seizure claim increases two- to six-fold among users adjusted for selected comorbidities and concomitant drugs. Risk of seizure is highest among those aged 25–54 years, those with more than four tramadol prescriptions, and those with a history of alcohol abuse, stroke, or head injury.[25] Dosages of warfarin may need to be reduced for anticoagulated patients to avoid bleeding complications. Constipation can be severe especially in the elderly requiring manual evacuation of the bowel.[citation needed] Furthermore, there are suggestions that chronic opioid administration may induce a state of immune tolerance,[31] although tramadol, in contrast to typical opioids may enhance immune function.[32][33][34] Some have also stressed the negative effects of opioids on cognitive functioning and personality.[35]

[edit] Physical dependence and withdrawal


Tramadol is associated with the development of physical dependence and a severe withdrawal syndrome.[36] Tramadol causes typical opiate-like withdrawal symptoms as well as atypical withdrawal symptoms including seizures. The atypical withdrawal symptoms are probably related to tramadol's effect on serotonin and norepinephrine re-uptake. Symptoms may include those of SSRI discontinuation syndrome, such as anxiety, depression, anguish, severe mood swings, aggressiveness, brain "zaps", electric-shock-like sensations throughout the body, paresthesias, sweating, palpitations, restless legs syndrome, sneezing, insomnia, tremors, and headache among others. In most cases, tramadol withdrawal will set in 12–20 hours after the last dose, but this can vary. Tramadol withdrawal lasts longer than that of other opioids; seven days or more of acute withdrawal symptoms can occur as opposed to typically three or four days for other codeine analogues. It is recommended that patients physically dependent on pain killers take their medication regularly to prevent onset of withdrawal symptoms and this is particularly relevant to tramadol because of its SSRI and SNRI properties, and, when the time comes to discontinue their tramadol, to do so gradually over a period of time that will vary according to the individual patient and dose and length of time on the drug.[37][38][39][40]

[edit] Psychological dependence and recreational use


Some controversy regarding the abuse potential of tramadol exists. Grünenthal has promoted it as an opioid with a lower risk of opioid dependence than that of traditional opioids, claiming little evidence of such dependence in clinical trials (which is true; Grünenthal never claimed it to be non-addictive). They offer the theory that, since the M1 metabolite is the principal agonist at μ-opioid receptors, the delayed agonist activity reduces abuse liability. The norepinephrine reuptake inhibitor effects may also play a role in reducing dependence.


It is apparent in community practice that dependence to this agent may occur after as little as three months of use at the maximum dose—generally depicted at 400 mg per day. However, this dependence liability is considered relatively low by health authorities, such that tramadol is classified as a Schedule 4 Prescription Only Medicine in Australia, and been rescheduled in Sweden rather than as a Schedule 8 Controlled Drug like opioids.[41] Similarly, tramadol is not currently scheduled by the U.S. DEA, unlike opioid analgesics. It is, however, scheduled in certain states.[42] Nevertheless, the prescribing information for Ultram warns that tramadol "may induce psychological and physical dependence of the morphine-type".


Dependence on Tramadol has been reported to be a major social problem in the Gaza Strip. The Hamas government has attempted to cut off supplies of the drug, and in April 2010 burnt 2 million tablets which had been intercepted while being smuggled into the territory.[43]


Due to the possibility of convulsions at high doses for some users, recreational use can be very dangerous.[44] Tramadol can, however, via agonism of μ opioid receptors, produce effects similar to those of other opioids (Codeine and other weak opioids), although not nearly as intense due to tramadol's much lower affinity for this receptor. Tramadol can cause a higher incidence of nausea, dizziness, loss of appetite compared with opiates which could deter abuse to some extent.[45] Tramadol can help alleviate withdrawal symptoms from opiates, and it is much easier to lower the quantity of its usage, compared with opioids such as hydrocodone and oxycodone.[46] It may also have large effect on sleeping patterns and high doses may cause insomnia.


(Especially for those on methadone, both for maintenance and recreation. Though there is no scientific proof tramadol lessens effects or is a mixed agonist-antagonist, some people get the impression it is, while someone else might benefit being prescribed both for pain and B/T pain)[47]


[edit] Detection in biological fluids


Tramadol and O-desmethyltramadol may be quantitated in blood, plasma or serum to monitor for abuse, confirm a diagnosis of poisoning or assist in the forensic investigation of a traffic or other criminal violation or a sudden death. Most commercial opiate immunoassay screening tests do not cross-react significantly with tramadol or its major metabolites, so chromatographic techniques must be used to detect and quantitate these substances. The concentrations of O-desmethyltramadol in the blood or plasma of a person who has taken tramadol are generally 10–20% those of the parent drug.[48][49][50]

[edit] Mechanism of action


Tramadol acts as a μ-opioid receptor agonist,[51][52] serotonin releasing agent,[53][54][3][4] norepinephrine reuptake inhibitor,[52] NMDA receptor antagonist,[55] 5-HT2C receptor antagonist,[56] (α7)5 nicotinic acetylcholine receptor antagonist,[57] TRPV1 receptor agonist,[58] and M1 and M3 muscarinic acetylcholine receptor antagonist.[59][60]


The analgesic action of tramadol has yet to be fully understood, but it is believed to work through modulation of serotonin and norepinephrine in addition to its mild agonism of the μ-opioid receptor. The contribution of non-opioid activity is demonstrated by the fact that the analgesic effect of tramadol is not fully antagonised by the μ-opioid receptor antagonist naloxone.


Tramadol is marketed as a racemic mixture of the (1R,2R)- and (1S,2S)-enantiomers with a weak affinity for the μ-opioid receptor (approximately 1/6000th that of morphine; Gutstein & Akil, 2006). The (1R,2R)-(+)-enantiomer is approximately four times more potent than the (1S,2S)-(–)-enantiomer in terms of μ-opioid receptor affinity and 5-HT reuptake, whereas the (1S,2S)-(–)-enantiomer is responsible for noradrenaline reuptake effects (Shipton, 2000). These actions appear to produce a synergistic analgesic effect, with (1R,2R)-(+)-tramadol exhibiting 10-fold higher analgesic activity than (1S,2S)-(–)-tramadol (Goeringer et al., 1997).


The serotonergic-modulating properties of tramadol give tramadol the potential to interact with other serotonergic agents. There is an increased risk of serotonin toxicity when tramadol is taken in combination with serotonin reuptake inhibitors (e.g., SSRIs), since these agents not only potentiate the effect of 5-HT but also inhibit tramadol metabolism.[citation needed] Tramadol is also thought to have some NMDA antagonistic effects, which has given it a potential application in neuropathic pain states.


Tramadol has inhibitory actions on the 5-HT2C receptor. Antagonism of 5-HT2C could be partially responsible for tramadol's reducing effect on depressive and obsessive-compulsive symptoms in patients with pain and co-morbid neurological illnesses.[61] 5-HT2C blockade may also account for its lowering of the seizure threshold, as 5-HT2C knockout mice display significantly increased vulnerability to epileptic seizures, sometimes resulting in spontaneous death. However, the reduction of seizure threshold could be attributed to tramadol's putative inhibition of GABA-A receptors at high doses.[55]


The overall analgesic profile of tramadol supports intermediate pain, especially chronic states. It is slightly less effective for acute pain than hydrocodone, but more effective than codeine. It has a dosage ceiling similar to codeine, a risk of seizures when overdosed, and a relatively long half-life making its potential for abuse relatively low amongst intermediate strength analgesics.


Tramadol's primary active metabolite, O-desmethyltramadol, is a considerably more potent μ-opioid receptor agonist than tramadol itself, and is so much more so that tramadol can partially be thought of as a prodrug to O-desmethyltramadol. Similarly to tramadol, O-desmethyltramadol has also been shown to be a norepinephrine reuptake inhibitor, 5-HT2C receptor antagonist, and M1 and M3 muscarinic acetylcholine receptor antagonist.[citation needed]

[edit] Chemistry

[edit] Characteristics


Structurally, tramadol closely resembles a stripped down version of codeine. Both codeine and tramadol share the 3-methyl ether group, and both compounds are metabolized along the same hepatic pathway and mechanism to the stronger opioid, phenol agonist analogs. For codeine, this is morphine, and for tramadol, it is the O-desmethyltramadol.

[edit] Comparison with related substances


Structurally, tapentadol is the closest chemical relative of tramadol in clinical use. Tapentadol is also an opioid, but unlike both tramadol and venlafaxine, tapentadol represents only one stereoisomer and is the weaker of the two, in terms of opioid effect. Both tramadol and venlafaxine are racemic mixtures. Structurally, tapentadol also differs from tramadol in being a phenol, and not an ether. Also, both tramadol and venlafaxine incorporate a cyclohexyl moiety, attached directly to the aromatic, while tapentadol lacks this feature. In reality, the closest structural chemical entity to tapentadol in clinical use is the over-the-counter drug phenylephrine. Both share a meta phenol, attached to a straight chain hydrocarbon. In both cases, the hydrocarbon terminates in an amine.

[edit] Synthesis and stereoisomerism


(1R,2R)-Tramadol (1S,2S)-Tramadol

(1R,2R)-Tramadol (1S,2S)-Tramadol

(1R,2S)-Tramadol (1S,2R)-Tramadol

(1R,2S)-Tramadol (1S,2R)-Tramadol


The chemical synthesis of tramadol is described in the literature.[62] Tramadol [2-(dimethylaminomethyl)-1-(3-methoxyphenyl)cyclohexanol] has two stereogenic centers at the cyclohexane ring. Thus, 2-(dimethylaminomethyl)-1-(3-methoxyphenyl)cyclohexanol may exist in four different configurational forms:







The synthetic pathway leads to the racemate (1:1 mixture) of (1R,2R)-isomer and the (1S,2S)-isomer as the main products. Minor amounts of the racemic mixture of the (1R,2S)-isomer and the (1S,2R)-isomer are formed as well. The isolation of the (1R,2R)-isomer and the (1S,2S)-isomer from the diastereomeric minor racemate [(1R,2S)-isomer and (1S,2R)-isomer] is realized by the recrystallization of the hydrochlorides. The drug tramadol is a racemate of the hydrochlorides of the (1R,2R)-(+)- and the (1S,2S)-(–)-enantiomers. The resolution of the racemate [(1R,2R)-(+)-isomer / (1S,2S)-(–)-isomer] was described[63] employing ®-(–)- or (S)-(+)-mandelic acid. This process does not find industrial application, since tramadol is used as a racemate, despite known different physiological effects [64] of the (1R,2R)- and (1S,2S)-isomers, because the racemate showed higher analgesic activity than either enantiomer in animals[65] and in humans.[66]

[edit] Metabolism


Tramadol undergoes hepatic metabolism via the cytochrome P450 isozyme CYP2B6, CYP2D6 and CYP3A4, being O- and N-demethylated to five different metabolites. Of these, O-desmethyltramadol is the most significant since it has 200 times the μ-affinity of (+)-tramadol, and furthermore has an elimination half-life of nine hours, compared with six hours for tramadol itself. As with codeine, in the 6% of the population that have increased CYP2D6 activity (increased metabolism), there is therefore a reduced analgesic effect. Phase II hepatic metabolism renders the metabolites water-soluble, which are excreted by the kidneys. Thus, reduced doses may be used in renal and hepatic impairment.[67]

[edit] Legal status


Tramadol (as the racemic, cis-hydrochloride salt), is available as a generic in the U.S. from any number of different manufacturers, including Caraco, Mylan, Cor Pharma, Mallinckrodt, Pur-Pak, APO, Teva, and many more. Typically, the generic tablets are sold in 50 mg tablets. Brand name formulations include Ultram ER, and the original Ultram from Ortho-McNeil (cross-licensed from Grünenthal GmbH). The extended-release formulation of tramadol—which, amongst other factors—was intended to be more abuse-deterrent than the instant release) allegedly possesses more abuse liability than the instant release formulation.[citation needed] The U.S. Food and Drug Administration (FDA) approved tramadol in March 1995 and an extended-release (ER) formulation in September 2005.[68] It is covered by U.S. patents nos. 6,254,887[69] and 7,074,430.[70][71] The FDA lists the patents as scheduled for expiration on May 10, 2014.[70] However, in August 2009, U.S. District Court for the District of Delaware ruled the patents invalid, which, if it survives appeal, would permit manufacture and distribution of generic equivalents of Ultram ER in the United States.[72]


Sweden, as of May 2008, has chosen to classify tramadol as a controlled substance in the same way as codeine and dextropropoxyphene. This means that the substance is a scheduled drug. But unlike codeine and dextropropoxyphene, a normal prescription can be used at this time.[73] In Mexico, combined with paracetamol and sold under the brand name Tramacet, it is widely available without a prescription. In most Asian countries such as the Philippines, it is sold as a capsule under the brand name Tramal, where it is mostly used to treat labor pains.

[edit] Proprietary preparations


Grünenthal GmbH, which still owns the patent on Tramadol, has cross-licensed the drug to pharmaceutical companies internationally. Thus, Tramadol is marketed under many trade names around the world, including:


Acugesic (Malaysia, Singapore)

Adolonta (Spain)

Algifeno (Bolivia)

Algesia (Philippines)

Anadol (Bangladesh, Thailand)

Boldol (Bosnia, Herzegovina)

Calmador (Argentina)

Campex (Pakistan)

Contramal (Belgium, France, India, Italy, Turkey, Sudan)


Dolcet (combined with paracetamol)(Philippines)

Dolol (Denmark)

Dolzam (Belgium, Luxembourg)

Dromadol (United Kingdom)

Exopen (South Korea)

Ixprim (France, Ireland)

Lumidol (Bosnia, Herzegowina, Croatia)

Mabron (Bahrain, Bangladesh, Bulgaria, Czech Republic, Estonia, Iraq, Jordan, Latvia, Lithuania, Malaysia, Oman, Romania, Singapore, Slovakia, Sri Lanka, Sudan, Yemen)

Mandolgin (Denmark)



Matrix (combined with paracetamol) (Honduras, Guatemala)




Nobligan (Argentina, Denmark, Iceland, Mexico, Norway, Portugal, Sweden)

Osteodol (India)

Oxxalgan PR (Greece)

Palitex (India)

Poltram (Poland)

Pyredol (combined with paracetamol) (Vietnam, Bolivia)

Ralivia (Canada)

Ryzolt (United States)

Sinergix (combined with ketorolac) (Mexico)

Sintradon (Serbia)

Siverol (Philippines)

Tandol (South Korea)

Tiparol (Sweden)

Tonoflex (Pakistan)

Topalgic (France)

Tradol (Bangladesh, Ireland, Mexico, Singapore, Venezuela)

Tradolan (Austria, Denmark, Finland, Iceland, Romania, Sweden)

Tradolgesic (Thailand)

Tradonal (Belgium, Indonesia, Italy, Luxembourg, Netherlands, Philippines, Spain, Switzerland)

Tralgit (Czech Republic, Georgia, Romania, Slovakia)

Tralodie (Italy)

Tramacet (combined with paracetamol) (Canada, Mexico, Costa Rica, South Africa)

Tramacip (India)

Tramadex (Israel)

Tramadin (Finland)

Tramadol HEXAL (Denmark, Finland, Germany)

Trexol (Mexico)

Trumen (Bangladesh)




Tramadol (Australia, Belgium, Chile, Estonia, France, Netherlands, Romania, New Zealand, Norway, Spain, United States)

Tramadol Stada (Sweden)

Tramadolor (Austria, Estonia, Germany, Hungary, Latvia, Lithuania, Luxembourg, Romania)

Tramagit (Romania)

Tramahexal (Australia)

Tramake (United Kingdom)

Trama-Klosidol (Argentina)

Tramal (Pakistan, Netherlands, Finland, Croatia, Morocco, Slovenia, Poland, Brazil, Chile, Romania, Australia, New Zealand, Germany, Switzerland, Lebanon, Israel, Philippines, Egypt)

Tramalgic (Hungary)

Tramal Gotas (Ecuador)

Tramazac (India, Myanmar, Sri Lanka)


Tramedo (Australia)

Tramoda (Thailand)

Tramól (Iceland)

Tramundal (Austria)

Tridol (South Korea)

Tridural (Canada)

Trodon (Serbia)




Ultracet (combined with paracetamol)


Ultram and Ultram ER (United States)

Ultramed (combined with paracetamol) (India)

Veldrol (Mexico)


Volcidol (Thailand)

Zafin (combined with paracetamol) (Chile)

Zaldiar (combined with paracetamol) (Belgium, Chile, Croatia, the Czech Republic, Mexico, Poland, Portugal, Slovenia, Spain, Russia)

Zaledor (combined with paracetamol) (Chile)

Zamadol (United Kingdom)

Zamudol (France)

Zodol (Chile, Ecuador, Peru)

Zydol (United Kingdom, Ireland, Australia)

Zytram (Canada, Iceland, New Zealand, Spain)

Zytrim (Spain)


[edit] Veterinary medicine


Tramadol may be used to treat post-operative, injury-related, and chronic (e.g., cancer-related) pain in dogs and cats[74] as well as rabbits, coatis, many small mammals including rats and flying squirrels, guinea pigs, ferrets, and raccoons. Tramadol comes in ampules in addition to the tablets, capsules, powder for reconstitution, and oral syrups and liquids; the fact that its characteristic taste is distasteful to dogs, but can be masked in food, makes for a means of administration. No data that would lead to a definitive determination of the efficacy and safety of tramadol in reptiles or amphibians is available at this time, and, following the pattern of all other drugs, it appears that tramadol can be used to relieve pain in marsupials such as North American opossums, Short-Tailed Opossums, sugar gliders, wallabies, and kangaroos among others.


Tramadol for animals is one of the most reliable and useful active principles available to veterinarians for treating animals in pain. It has a dual mode of action: mu agonism and mono-amine reuptake inhibition, which produces mild anti-anxiety results. Tramadol may be utilized for relieving pain in cats and dogs. This is an advantage because the use of some non-steroidal anti-inflammatory substances in these animals may be dangerous.


When animals are administered tramadol, adverse reactions can occur. The most common are constipation, upset stomach, decreased heart rate. In case of overdose, mental alteration, pinpoint pupils and seizures may appear. In such case, veterinarians should evaluate the correct treatment for these events. Some contraindications have been noted in treated animals taking certain other drugs. Tramadol should not be co-administered with selegiline or any other psychoactive class of medication such as selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, or monoamine oxidase inhibitors. In animals, tramadol is removed from the body via liver and kidney excretion. Animals suffering from diseases in these systems should be monitored by a veterinarian, as it may be necessary to adjust the dose.


Dosage and administration of tramadol for animals: in dogs for sufficient analgesia: 1–4 mg/kg PO q8-12h (Hardie, Lascelles et al. 2003) and to control chronic pain in cats: 4 mg/kg PO twice daily (Note: Dose extrapolated from human medicine. Tramadol has not been evaluated for toxicity in cats and has not been used extensively, but early results encouraging) (Lascelles, Robertson et al. 2003).


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tramond, sounds like you had an allergic reaction. What did the doctor say about it?

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Hoi Alto! I will See him Tomorrow! Don't Know Howe to Talk to him! Have tovtake Care Not to wish him horrible pain and Symptoms every Single Day on His Life!!! He knows about my Disc. Syndrom from Effexor and Lüttich me ob Tramal! What Kind of Doctor is this?? Horrible leasy Not knowing the responsabillity of their Job! Seems like He got His licence at the Lotterie ! I am just in Gote about them!!!i think He Neefs s whipslash to get His Brain in Order( sorry I am in Rage)

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They don't know in advance if you'll be allergic to something, but he should have thought about it first.

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Tramadol is bad news. It screws around with neurotransmitters. Definitely should never be given to anyone who either is on, or has a past history of being on, any drugs that affect serotonin and/or norephinephrine.

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Hoi buddys


As I wrote I had an accident 3 month ago with a heavy whipslash! Since i do have pain and akes especially in the neck and head!


The strange thing is, I do have the expeiences of apin and akes witch comes and goes in a second! Feels like the nerve is giving an impulse or better like I get hidden with a hammer.......just for a second! The snap comes and goes on every part of my head...........just like it wants to! Moeving around!


I never experienced brainzaps but I ask myselfe is this similar???

For sure it is neurological pain!

As well my neck and backhead ist hot and crampy most time and my ears feel like they are under water or like you would hit me with a hand onto the ear!!


It is all verry strange! As well ma ankles on th hands and my right leg are akeing sometimes!!

Anny experience would be verry appriciated!!





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Hoi Rhi


That is exactly what I ment!!!!!


Was trying to explain it to the doctor!! And thought if I have to take an opioid painkiller so please give me Valoron(tilidin) because it works different!!!

He did not even listen to me!!!!!!





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Hoi all


I have been to the Ostheopath again yesterday! He gives verry good thearapie t heal the whipslash!

Yesterday he wondered that I do not have improvement and that my pain is not getting less. hes wondered because he had man other patients with harder whipslash and he could help them verry weell to improve!


I tolf him my storry about theAD WITHDRAWAL and he ment, that could be the point!

In his oppinion the SRI could have damaged my nerves and the sensitivity for apin and could manipulate the pain barrier in the brain!!!


I found out I do heve three kinds of pain¨


a pain in the neck and back head...........

a kind of pain dragging in the whole head, ears, teeth.............moveing aroung like it wants to

a kind of pain I like get s slap, like hidden in my head or brain!


Alltogether just a creyzy sensation!


I told him as well that since 10 mont I sleep just 2-4 hours a night! He was the first who said.....oh boy.............with so less sleep you get mad , everyone gets mad with sutch less sleep!

So I do have an appointment with a chinese doc on friday................will see if he can do something good for me..to get my mind more in equilibrio



Greets to all



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I moved your posts, here, tramond, to continue your experience with the osteopath.


Well, at least you have a doctor who gives credence to your story.


It is possible withdrawal has made you more sensitive to pain, and the withdrawal insomnia isn't helping either.


Does the Chinese doctor offer acupuncture? Many of us have found that helpful for pain and for withdrawal symptoms.

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Hoi buddys


Alto, thanks a lot for moveing my thread together!


The last days I have been in trrible pain (head, face, ears, teeth etc) and today(untill now) I do have a bit relief. Will say I am without analgetics until know!

But...........today I feel myselfe like flying through the world! It seem slike I am not conected to the floor and not to myselfe! The things are moveing and I have no feeling for the room around me!

Howeever....have been to the supermarket, and I am trying not let me overwhelm from this creazyness!

It is DR and DP together with the dizziness! My mouth is without anny taste and so on.....................! More often now, my feet get numb and it happend that I fall down when I want to stand up from the chair. Just because there is no feeling in my leg and I did not remember!!


I am in the situation where I can not decide annymore what is from the wd and what from the whipslash.......................bth is working with the CNS!


With my whipslash I do make the same expierences with the doctors, like I did with the AD and Benzo wd!!!

Whipslash is a common diagnose but...................all they help is nothing o absolutely contraproductiv!

Like I wrote allready, my doc gave me a prescription fro Tramal witch is the madest thing you can give me in my situation(Serotonin and Adrenalin)) I could go to get it in bottles if I wanted to! Told him about the way tramal works.he dont cares!

My neurologist (unbelievable) told me, that she likes the picture from Jesus on the cross! he suffers but all in dignity! So I should go and take my pain in dignity!!!!

HELLO..............that is no joke................I do life in switzerland in 2011!!!! Not in the djungle of Brazil!!


I wanted my doc to give me an MRI under function because it is the only possibility for a rela good diagnostik with whipslash!!........No...I dont need it!!

Take your tramal and thats it!!!


There are some verry good clinics for the diagnostik and therapy in whipslash but until now................they dont allowe me to get there!!!

Hm.........................they are not just ignorant hypocrites in the withdrawal from psych-drugs..............they are in every way!!!


There is something I found out.................help yourself....................no one other will!!

I will keep on fighting against these shrinks called doctor and I slap them with their oad of Hypokrates.


But the buddys in here....we are going together!

Greets to all



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Hoi buddys! It is anspitzend creazy Today! Ian verry dizzi and the while World is moveing around me! I feel like in a verry Bad Movie! The whole World around Me is just unreal and to mutch! I don't feel myselfe Inside my Body and I Walk like on a ship searching for something constant! I Must Look like a stinken Robot! Ehen I Sir, i do have the sensation As I could Not stand up annymore! Like my Brain says stand up but my Body can Not follow! That Makes me verry anxious and I have to take all my Power together Not to Fall inbpanic!i have been at the Ostheopathen Today and in here oppinion all my constant pain (Head, neck, ears, teeth) is Not because of the whipslash! My vertreba is Not that damaged! The Other Thing is, i did Not take anny painmeds Today and the pain is Not more intensiv like the days with painmeds! If all this is withdrawal...... I wish all the involved creatures who made, sell, prescribe and allowe these drugs, hell on Earth for every Single hour they exist!!!

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Iam in a world between somehowe!

Boatyfeeling is getting worst, DR /DP verry heavy and the anxiety is getting more and more!

I have lost my life and teh feeling is growing, that I loose mymind and myselfe absolutely!!!





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tramond, please do what you can to stay calm and view the symptoms as symptoms that will slowly go away.


I know it's frustrating but that's about all you can do. You're still there, inside the symptoms, you're not lost.

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I hope you start feeling better soon Tramond. Like Alto says try to remain calm. Everything you are experiencing is coming from your body and mind trying to adjust to life without antidepressants. I am thinking of you and your difficulties in this process and hope you start to get at least some relief for a few hours every day. At first I only felt better for a bit in the evening but now I feel better more during the day too.

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Hoi alto, hoi lupe..thank you verry murch for your replies!!!


I try to stay calm but it is verry hard to practise!

In the night I get verry few sleep and I lay there ynxiety overwhelming me!

To get up in the morning is verry hard, because it is the start of another heavy day.just fighting through!

The thing is I have to cope with this nightmare of SSRI discontinuation syndrom and the symptoms from the whipslash witch is head and nervepain, facepain, ears etc!!!

To cope the SSRI stuff is absolutely heavy enough..................and the whipslash on the top............I fight every day that it will not break me!

I do have Tramadol but dont use it because I am affraid ! It works with Serotonin and noradrenalin.same like evil Effexor!


I can get as mutch as I want to.........but I have the feeling if I take it........I have lost the race!!!

So I stay in pain...........witch makes my brain and emotions more more bad!!

i am just sad............and thik...and I have the feeling I have to suffer all my life!!! And I WILL NOT!!!!


I keep all my power together to get through day and night somehowe................walking, sitting is allready work for me and to take a shower is a big act!!

i am not able to do my housework.........because I am verry powerless..no energie at all.........!!


If I look in the mirror there is just an old face with swolen red eyes, rudes, witch looks like a mask..........sad and without emotions and at least with eyes as sad like dead!


Here in switzerland we do have a society witch helps thik people in a legal way to get out of theri life! It is called exit. XYOu do have to be a member!!

At this point, I will not get out of my life. That for I am to mutch fighting..but..........I thin k to get amember is a good idea...........who knows !!!

Greets to all



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Hi... I feel your pain! I know what you mean about the upward struggle every day, and how exhausting it is. And I don't have whiplash! Have you tried acupuncture? Hang in there and believe you can get better!

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tramond, didn't you have a bad reaction to Tramadol?


I agree with Nadia, try acupuncture. I found it's very good for pain.

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Tramond, I know about that society called EXIT and its for people in their final stages of an incurable illness..

such as cancer or ALS for example.

What we have is not an incurable illness.

This is transient.

However, while in the deepest part of it, you can't help but wanting to exit.....just to get out of the pain.

I never thought I would heal from the most horrible benzo withdrawals which got me in places such as the Detox, Rehab, psych wards and loonybin.

I was useless to myself, my family and society for a very long time but eventually it all came out in the wash as we say here.

There was no sleep at all for 1 full year, massive anxiety 24/7, could not take showers on my own ( I took with me a hairbrush for soap and a chair for a towel) and I lived inside my own cocoon of severe DP and DR.

No messages coming in, no messages going out.

My eyes looked as dead as I felt inside.

I don't think I ever have been as frightened in my life.


If you can tell yourself this is but temporary, you might be able to feel a bit better.

Also live One Day At The TIme..this is a slogan out of addiction circles but it works when you work it.

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Hoi all!!

Yes.....I do craneosacraltherapie, Ostheopathie, ****opathie. akkupunkter at a chinese doctor, witch gives me tea as well!!


Yes I took the Tramal 2 times...and in 10 minutes I had the itching allover my body!!!


It is not only the wd buddys.........................it hit me once more............with the slap on my head!!

I dont know why I got this slap in my badest year ever!!! Just to make me suffer more and more hopeless!!


I do so many things to get the pain in a limit.but.................for nothing!!!


Will not frustrate you.....sorry!!!!


I think I have to decide......going through the wd and the imense pain day by day...or getting addicted to morphin...............finaly with a totaly mad brain in a very short time!!!


Maybe this is Destiny.........Schicksal......khismed??????


Greets to all and thank you erry mutch for the responses!!!



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Leon, we have therapists here who help people with pain management. They don't administer drugs, they have other ways to teach people how to cope with pain.


Do you have this kind of therapist in Switzerland?


Withdrawal syndrome may have made you more sensitive to the pain from the head and neck injury, generating pain in a chronic pain syndrome.


I know pain management therapy can work wonders. I know of a young woman who was in terrible pain from a bad operation, and she became hypersensitive to drugs, too. The pain management therapists are helping her so her body can heal and stop sending out pain signals.

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Hoi alltogether and thank you for your rsponses!


Yes there are paintherapists in switzerland but it is a long way to come to them! before you have to go through the maschine of diagnostik etc!!!


The thing is, as You know, I do have to fight on two lines! The disc-syndrom and the whipslash!


Instead of better i feel more worst day by day! Ma head is so full and empty at the same time and it feels as there would be a thunderstorm inmy head!


I feel verry powerless, dont have energie for nothing! To take a shower and dress myselfe is A BIG WORK!!


I am verry depressed and sad, time passes by and for me it does not care what day is today! its just another day in hell!

I do lay in bed more or less 12 Hours a night and sleep just 2-4 hours. The rest is just laying down with thousands of pictres are moveing through my head!

I see myselfe in the mirror........my face bacame old, frustrated, and I just look thik!


I am gelous every morning when I think a normal person is geting out of the bed now and stating a new day! With all the ups and downs!

And I am just here not here....somewhere because my DR and DP is so heavy that I dont know at the end where are I am????


My brain feel like I do have dementia and I think it is a kind of dementia!

My life slipt away, my independence, my joy, fun, ...................everything witch is important to have a regular life slipt away!!

I am not alive....I am not dead...........I am just in a suffering world between!!


I aks myselfe buddys, howe is it possible they sell this drugs more and more............when everyone can see, what this drugs are doing!!!

Are we just marionettes??

It is like in a verry bad sience-fiction movie!! where they put a kind of microchip in your prain to make you function as they want to!!


Feel destroied, feel not able to hold my life together.............I feel helpless and hopeless.......lifing in a world between........and I ask myselfe WHY???????

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Don't ask yourself why. It would entailed the painful review of the dark and lousy side of humanity. You don't need that at all.


I don't know if it could help you, but I garantee you I deeply understand the feelings tormenting you. Really. You are not alone suffering like this. I think that suffering insidiously creates a loneliness which worsens the suffering. You feels lost and alone in a desert world, a gloomy and emtpy alternative dimension. It's an atrocious feeling. But you are not alone. These dimension is not only yours. There is a vast number of people suffering like in hell. In a way, you are part of a "community".


You seems to suffer a lot from loneliness. Suffering alone is the worst thing a human being can experience. Please, try to break your loneliness. If you cannot do it physically, try a very good substitute: reading. It will prevent your mind from brooding and feeling alone. It works with me.


Try to entertain your mind and seek human contact.


Hang on, it's just a temporary state.


I'm so sorry for what you are experiencing.

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Reading is a wonderful escape for me as well.

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Hoi mixo and nadja


You are absolutely wright.when You describe howe we feel!

i feel lost and alone even if my daughter or my partner is around me!!!

Like there is no way to break through or get to them!


As you know, I had a whipslash and suffer strange headaches, and facepain since!

I have had similar pain allready before but they changed and went a way to come up again! However this kind of headaches and facepain is different!


Yesterday i could not handle the pain annymore and i thought ok............I get 20 drops of Tramal!

I had a more or less painfree day from 10 to 18 o clock! But it was to aspect....I got this itching allvover my body!

Today the headpain keeps bareable but my face is like every muscle is under tension........a warm burning under my skin of the head...like neurophatie!


Tramal is working with serotonin and adrenalin..the way like effexor does!

I wonder once again..............is all this strange pain from the AD withdrawal.................is it the whipslash.....is it both???

Howeever......it is creazy to see when I give sertonin to my body(in this falt tramadol) the pain moves away!!!


There are manny people suffering fubromyalgia after ADs!! Do they give us permanent pain?


As well my ankles (hand) my feet and the muscles of my legs are hurting sometime............as well the back of my hands...all just strange!!


Greetings to all



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