Will Tramadol have long-standing effects same as that of Ketamine in major depression?

Question

Hello doctor,

My 19-year-old son is suffering from major depression and has been on at least four different medications, ECT and Ketamine treatments.

ECT and the Ketamine seem to show the best results so far but are short-lived. And I hate to keep shocking his brain if this is not going to work (He has completed 10 sessions now). All I have been doing is research on how to help him because I know his doctor has only one hour with him every two or three weeks where I am with him every day for hours. I ran across an article about using Tramadol to treat depression and I was wondering if taking this every day would produce the same (or near same) effects that the Ketamine treatments do but over a longer time?

Right now he is on Cymbalta 90 mg, Rexulti 0.5 mg, Wellbutrin 150 mg, Hydroxyzine 50 mg (as needed), Clonazepam 0.5 mg (as needed).

Answer 1

Hello,

Welcome to icliniq.com.

Resistant or long-standing depression needs treatment with a mood stabilizer that has not been given the list on ongoing medicines. I would recommend that you add a mood stabilizer like Divalproex sodium or Lithium Carbonate. It will help hold the mood in place once it has been elevated by antidepressants. Also, Cymbalta is not a very good antidepressant. It is the least potent among SNRI (serotonin-norepinephrine reuptake inhibitor) class of drugs.

Normally, after this you can try using a TCA (tricyclic antidepressants) class of antidepressant and if that does not help then a combination of Venlafaxine and Mirtazapine is highly effective. It is also been evidenced by Star-D trials, the largest clinical trials for resistant depression. This is also my clinical experience.

In addition to the primary antidepressant (SSRI or SNRI or TCA), and the mood stabilizer, also an atypical low dose antipsychotic will augment the efficacy of the antidepressant such as 50 to 100 mg of Amisulpride, or 5 mg of Aripiprazole, etc. So, there are a lot of options available which have not been tried and I would request you to consider these first, in addition to the ongoing therapies.

And finally, do not use Tramadol daily that would lead to an opioid type of dependence and ultimately worsen his depression.