Similar effects of tramadol and venlafaxine in major depressive disorder.

The analgesic tramadol has many characteristics in common with the antidepressant venlafaxine. The drugs are structurally similar, share both serotonergic and noradrenergic properties, and undergo a similar metabolic fate. In this study, a patient, who developed significant depression following cessation of tramadol after several years of therapy, is described. Her depression was then treated with venlafaxine with excellent response. It appears that tramadol may have provided a prophylactic antidepressant effect in this patient. Because of its similarities to venlafaxine, tramadol may possibly exert a degree of antidepressant effect in certain patients, particularly those with chronic pain.

SSRIs & the risk of abnormal bleeding.

Considerable research is needed to fully understand the interactions of SSRIs and hematological functioning. Adequate studies of platelet function in patients taking SSRIs are lacking. The risk of bleeding with SSRI treatment appears to be low, and the occurrence of bleeding is usually minor when it does occur. However, the risk does exist and must be considered in any patient taking SSRIs who develops abnormal bleeding or bruising not otherwise explained by an appropriate assessment to determine the etiology. Routine monitoring of patients taking SSRIs should probably include questions about bruising or bleeding, particularly in patients with blood dyscrasias and in older patients taking medications that affect platelet function. Caution should be exercised before starting patients with preexisting bleeding risks on SSRIs, including patients taking NSAIDs, aspirin, or other drugs that may impair coagulation.