B Oronsky, R Martin
bipolar disease, tramadol
B Oronsky, R Martin. Intolerance to Tramadol may Herald Bipolar Disease. The Internet Journal of Family Practice. 2007 Volume 6 Number 2.
The association between Tramadol and mania has been reported in a few anecdotal reports.
Three cases of mania coinciding with Tramadol administration are presented. The patients all reported excellent analgesic response to Tramadol after it was restarted in combination with a mood stabilizer.
These cases suggest a possible association between Tramadol and mania. Intolerance to Tramadol may even signal an underlying untreated manic depression. In this case, consideration should be given to restarting the Tramadol in combination with a mood stabilizer.
There have been only a few case reports associating Tramadol and mania. Tramadol is a centrally acting analgesic that preferentially binds the mu opiate receptor and inhibits the neuronal uptake of serotonin and noradrenalin2. The serotonergic and noradrenergic modulating properties of Tramadol suggest an antidepressant effect which could result in the induction of mania itself in a manner similar to that of antidepressants3. The main reported side effects of Tramadol are nausea, abdominal pain and headaches1. We are reporting three patients whose manic behavior may be associated with Tramadol therapy.
We have presented three patients with initially untreated bipolar disease that came to our clinic for treatment of chronic or persistent pain. Tramadol may have had an adverse effect in these patients by triggering or exacerbating their manic symptoms. Tramadol-induced mania, likely due to the drugs inhibitory effects on noradrenalin and serotonin neuronal reuptake, has already been reported in the literature4. However, when used with the moderating effects of a mood stabilizer, these patients reported improved analgesic control. Based on these examples, we recommend that all patients should be rigorously screened for symptoms of bipolar disease before starting treatment with Tramadol. Furthermore, we suggest that intolerance to Tramadol may herald a previously undiagnosed bipolar disorder and should prompt the physician to consider the diagnosis. In light of the clinical analgesic benefits of Tramadol and history of minimal abuse potential, a retrial of the drug may be warranted in patients with bipolar disease perhaps in combination with a mood stabilizer.