Tramadol Withdrawal – Advice on Coping with Discontinuation Symptoms
In the first article you learned about the two components of tramadol withdrawal (opiate-based and antidepressant-like) what to expect from withdrawal and about how to set up a tapering program to minimize your discomfort. In this article, you’ll learn effective coping strategies for managing the withdrawal symptoms you do face.
Read on to learn about:
- Medication and home-remedy options for coping with opiate withdrawal symptoms
- Medication and home-remedy options for coping with atypical (antidepressant-like) withdrawal symptoms
Medications for Opiate Withdrawal Symptoms
If you taper slowly enough you may not experience any severe symptoms.
If you taper rapidly or stop abruptly, you’ll likely experience opiate-like withdrawal symptoms (and possibly atypical withdrawal symptoms). You can relieve some of the discomfort of these opiate-type withdrawal symptoms with common OTC and prescription medications. Talk to your doctor about which OTC or prescription medications might help you.
According to an Australian Drug and Clinical Advisory Service (DACAS) withdrawal management publication, as of 2009, medications endorsed to reduce the severity of opiate withdrawal symptoms include:
- For nausea and vomiting - metocloperimide, prochlorperazine or if very severe, ondansetron
- For diarrhea - loperimide (Immodium)
- For abdominal cramps - antispasmodics like Buscopan
- For muscle and joint pains - NSAIDs like ibuprofen and common acetaminophen
- For anxiety, sweating and other physical symptoms associated with an overactive sympathetic nervous system - clonidine
- For anxiety and insomnia - diazepam (Valium)
- For restless legs - diazepam1
Restless legs are a common and hard-to-manage symptom of tramadol withdrawal. Read Coping with Restless Legs for a full exploration of coping strategies and tips for minimizing the discomfort.
Methadone or Suboxone for Tramadol Addiction?
Some people would call you crazy for switching from the partial opiate agonist tramadol to stronger Suboxone or the full opiate agonist methadone. However, in certain situations, such as when addiction and compulsive use make controlled reductions impossible and when cold-turkey stoppage is inappropriate or unacceptable, opiate substitution medications could reduce risks and improve quality of life.
The Basic Facts
- Methadone and Suboxone are substitution medications. They switch for an abused opiate in the brain by activating opiate receptors at a dose that eliminates withdrawal symptoms but doesn’t induce intoxication.
- However, since tramadol changes the opiate system and the serotonin/norepinephrine systems, any medication that only activates the opiate system addresses only half the situation, and even after titrating onto methadone or Suboxone, you’d still be potentially facing atypical withdrawal symptoms.
So methadone and Suboxone could help, but they only offer partial respite and are dependence inducing drugs. These drugs could possibly serve as one component of a treatment program for a person with very compulsive tramadol use, such as a person who couldn’t manage a taper, but these are serious medications that shouldn’t be considered until you have a full understanding of their benefits and risks.
According to Suboxone expert Dr. Jeffrey T. Junig of Suboxone Talk Zone, you could switch (under close medical supervision) off tramadol and onto Suboxone and possibly then add an SSRI. Before switching onto an SSRI you'd have to stop tramadol and possibly even leave a time gap to allow excess serotonin to clear from your brain (to avoid the serotonin-syndrome-inducing combo of tramadol and SSRIs). Then, once stabilized, taper off the SSRI while deciding whether or not to stay on Suboxone indefinitely. Whether this makes sense for you is something to decide for yourself after discussing your options with your doctor.2
20 Home-Remedy Coping Ideas for Opiate Withdrawals
Beyond medications, here are 20 no-risk ideas and activities that may help take the edge off your opiate based tramadol withdrawal symptoms.
Whether you’re coping with mild withdrawal symptoms during a taper or the full-on experience of a sudden cold-turkey stoppage, there’s no denying the discomfort of opiate withdrawals.
OTC and prescription drugs can help, but beyond medications, you can also alleviate some of the discomfort through home-remedy style coping strategies.
Here’s a list of 20 ideas to get you started.
20 Home-Remedy Opiate Withdrawal Coping Ideas
The following coping strategies may help minimize your discomfort – or at least pass the time. Try any or all of the following.
- Stock up on light action/comedy movies and television shows to space out on.
- Try to get as much exercise as you can – even a walk around the block can help.
- Take lots of hot baths or hot baths with Epson salts
- Participate in online support forums.
- Stay hydrated, especially when dealing with diarrhea. Water, fruit juice, weak tea or Gatorade are good choices.
- Stock up on easy to prepare and digest snacks. You may not feel up to heavy meals for a while, but foods like crackers, pretzels, toast, popsicles, noodles and Jello are easy on your stomach and will help you keep your energy up. Avoid heavy or greasy foods, heavily spiced or aromatic foods and alcohol and caffeine.
- Eat foods cold or at room temperature to reduce nausea-provoking smells.
- Have someone else cook for you – so you don’t have to face food-preparation smells.
- Eat in a well ventilated room (stuffy rooms can add to feelings of nausea.)
- Eat slowly, avoid drinking liquids with your meal and avoid lying down for a while after you finish eating.3
- Get outside and get some fresh air (sometimes you have to force yourself off the couch but you’ll rarely feel worse for taking a shower and walking around a bit…and you may feel quite a lot better.)
- To ease achy pains or restless legs, have a loved-one give you a massage.
- Take a daily multivitamin (skip this one if you find vitamins increase your nausea).
- Try deep breathing exercises, meditation, progressive muscle relaxation or yoga to combat stress and anxiety.
- Do stretching exercises to relieve muscle pain.
- Use a hot pad.
- Have an orgasm.
- Change your sheets (this can help with insomnia, especially if you’ve been sweating excessively).
- Clear your calendar from responsibilities and lean on your friends and family for help and support. If you can get a week free, that’s a great start.
- Play video games or other games that keep you mentally absorbed (to keep your mind off your discomfort).
Coping with Atypical Withdrawal Symptoms
Atypical withdrawal symptoms are probably caused by serotonin imbalances in the brain. Your brain will revert to pre-tramadol functioning in time, but until it does, insufficient serotonin and norepinephrine in the brain can leave you feeling pretty miserable.
When facing atypical withdrawal symptoms, you have 2 basic options:
- Slow the taper, or to return back to a dose that was manageable and then taper more slowly from that point.
- Continue with the taper as scheduled, and try to treat the symptoms.
Managing Atypical Withdrawals with Medications
You often see people on internet forums recommending drugs like dextromethorphan cough syrups or even SSRI antidepressants as a way to minimize atypical tramadol withdrawals. Is this a good idea?
Well, it might work, but it’s also an extremely dangerous practice, so in virtually all situations, it’s not something you want to try on your own.
The Dangers of Serotonin Syndrome
Since you experience atypical withdraw symptoms from too little serotonin, you can reduce the severity of atypical withdrawal symptoms with medications that increase serotonin or serotonin and norepinephrine levels in the brain.
However, taking any serotonin-increasing medication at the same time as serotonin-increasing tramadol puts you at risk of serotonin syndrome – this is definitely not something to consider without your doctor’s full endorsement.
- Serotonin syndrome = A life-threatening condition of too much serotonin in the brain that occurs most usually after taking a combination of drugs that raise serotonin levels.
Note - Even if considering medications to raise your serotonin levels after complete tramadol stoppage (abstinence) you still need to make sure that you leave enough of a gap between your last tramadol tablet and your first tablet of your new serotonin-increasing medication – Best to discuss this with your doctor.
Some (not all) examples of medications that raise serotonin levels include:
- SSRISs or SNRIs
- Dextromethorphan (DXM – a cough syrup ingredient) the herbal supplement
- St. John’s Wort
- Triptan migraine medications
- 5-HTP supplements
- Many others
The Take-Home Message
Though you see people recommending the use of serotonin-bumping medications on tramadol forums, this isn’t something to take lightly. Remember:
- Combining serotonin-raising medications puts you at serious risk of serotonin syndrome
- If you decide to consider combining serotonin-increasing medications, make sure to only do so under a doctor’s observation and guidance.
- Consider whether a very gradual straight tramadol taper may achieve the same results with less risk.
As a side note, illicit drugs that bump serotonin levels, like MDMA or LSD – are also a dangerous idea when mixed with tramadol, and substances that alter the metabolism of tramadol, such as CYP2D6 and CYP3A4 inhibitors, can also increase the risks of serotonin syndrome. Grapefruit juice is one example of a seemingly innocuous substance that actually works as a major CYP3A4 inhibitor and thus drug potentiator.
Managing Atypical Symptoms
Fortunately, though serotonin-elevating medications aren’t safe, you can still take steps to improve your situation.
Here are a few ideas.
Compensate – Work to Make Yourself Feel Better
When tapering or in withdrawal, you not only lose that happy-sociable tramadol energy that made feeling good so easy – you may also feel rebound depression, irritability and anxiety.
So though you won’t feel like it, if you can force yourself into feel-better activities like exercise or social outings, you can usually lift your mood - at least a little bit.
Get Online Support
It feels better to know that others are having similar experiences – and that full recovery is possible.
Find an online community of others withdrawing from tramadol. Tell your story and get support. Read about other people’s journeys and help with advice when you can – and maybe learn new ideas when you can’t.4
Work with Your Doctor
Stay in regular contact with your doctor as you taper off, and if certain symptoms get too severe to manage, your doctor may prescribe an anti-anxiety, analgesic or sleeping aid medication to help you get through the toughest times.5
Raising Serotonin Naturally
Insufficient serotonin in the brain during tramadol tapering/abrupt cessation causes unpleasant withdrawal symptoms. Taking other drugs or herbal substances that raise serotonin levels puts you at risk of serotonin syndrome, but fortunately, you can safely increase your serotonin levels through lifestyle and dietary changes and exercise.
Try and or all of the following ideas:
Get Some Sun (or Indoor Bright Light)
Serotonin levels fall with insufficient sun exposure, so spend some time in the sun or exposed to very bright indoor lights each day (seasonal affective disorder lamps hold 300 watt bulbs and can boost serotonin levels after just 3, 20 minute sessions per day.)6
Though serotonin’s precurser (trytophan) comes from protein-rich foods like meat and nuts, it’s carbohydrate-rich meals that really raise neural serotonin levels. This is because carbohydrate-rich meals cause an insulin bump that pulls competing amino acids out of the bloodstream and into the muscles - leaving tryptophan free to pass into the brain without amino acid competition.7
Try whole grains, legumes and other complex carbs for lasting benefits.
One of the easiest ways to decrease the severity of serotonin-linked tramadol withdrawal symptoms is to lace up your running shoes and go for a jog (or a brisk walk - or whatever other aerobic activity you enjoy.)
Vigorous exercise increases serotonin release in the brain.8
And as an added benefit, exercise can help to alleviate anxiety, stress and insomnia - and if nothing it else, it can provide a brief distraction from your focus on the negatives of withdrawals.
Researchers at the University of Miami School of Medicine say that massage therapy increases serotonin and dopamine levels while decreasing levels of the stress hormone cortisol. In a review of studies for a wide range of conditions (in which serotonin markers in urine were measured after a massage intervention) the researchers found that on average, massage therapy increased serotonin markers by a whopping 28%.9
- DACAS Withdrawal Management Clinical Resources
- Suboxone Talk Zone: Dealing with Ultram Withdrawal
- University of California San Francisco: Diet Modifications for Nausea
- Psych Central: Preparing for Antidepressant Withdrawal
- Harvard Health-Watch: Going off Antidepressants
- WebMD: Fighting Winter Depression
- WebMD: Serotonin
- Serotonin Mediates Exercise-Induced Generation of New Neurons
- Massage Therapy and Serotonin Increases
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