Despite being as important as physical health, mental health sadly goes unnoticed or untreated and has only started getting the justified medical attention it deserves. Lack of awareness or social stigma associated with it and lack of access to quality mental health services are some of the chief factors behind its limited diagnosis. Irrespective of the cause, statistics and logistical reports have confirmed that mental health issues are rising globally. It is estimated that 1 in every seven people suffer from mental issues worldwide, and the problem will increase with time.
A word about mental health and its treatment options
Depression, anxiety disorders, bipolar disorders, and eating disorders are some of the chief mental health problems affecting millions worldwide, out of which anxiety and depression are at the top of the list. Anxiety disorders are characterized by unnatural feelings of worry, anxiety, and fear that interferes with your day-to-day activities and are present in the form of panic attacks, eating disorders, PTSD, and OCD. Depression is characterized by a severe lack of interest in daily activities with a constantly depressed mood that impacts your life.
Some of the chief treatment options are psychotherapy and medications like antidepressants, anti-anxiety medications, antipsychotics, and mood-stabilizing drugs. Because of the higher addiction potential of the mental health of the drugs and the side effects associated with their use, low-acting opioids are sometimes considered off-label treatment options. Opioids were primarily developed for treating diarrhea and dysentery before being used in moderate to severe pain conditions. But in addition to working on the pain receptors, they can be used in low doses in depression and OCD conditions that are associated with psychological pain; pain because of emotional stress manifesting in the form of headache, backache, muscle pain, and abdominal pain of varying intensities.
Opioids and Tramadol
The historical utility of opioids in treating depression and evidence stemming from many preclinical studies suggest that low-acting opioids such as Tramadol 100mg may be a useful treatment option in mental health cases, especially when other treatments have failed. Tramadol is a synthetic opioid used in the management of moderate to severe pain and has an onset period of less than an hour. Conditions of chronic osteoarthritis, cancer-induced pain, and surgical pain are some of the few conditions treated by Tramadol. What makes it a choice option for mental health conditions is its strong potency and limited addiction potential, and safe nature
All opioids, including Tramadol, have a dual nature of action, i.e., they work on the presynaptic nerve terminals and postsynaptic neurons to bring out their therapeutic effects. Tramadol, in addition to binding to the mu-opioid receptors, inhibits the reuptake of serotonin and noradrenaline in the limbic system. Serotonin and noradrenaline are the neuroreceptors responsible for moods, anxiety, and in the regulation of sleep cycles, because of which their reuptake uplifts the mood and helps in the treatment of mental health problems.
Why Tramadol for mental health and OCD
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In a data mining approach used to assess the safety and effectiveness of Tramadol 100mg from a patient’s perspective, user reviews for Tramadol reported it to be the best among 34 other drugs, with almost 94.6% of patients having reported successful results after using it. Around 79.2% of patients in evaluated studies reported relief from depressive tendencies at low doses of the medication and could use it for a prolonged time without major adverse reactions or suffering serious side effects from its long-term use. The study of over 100 reviews coupled with the survey of biomedical literature has proved that Tramadol, at low therapeutic doses and in the absence of drug interactions, can be used as a safe and effective option in depression cases.
In addition to depression conditions, cases have also been recorded of successful results with the use of Tramadol for treating chronic pain conditions in patients with OCD. The Canadian Psychiatric association with the Anxiety Disorders Association of Canada have even proposed Tramadol as a third-line treatment for OCD and proposed using it as adjunctive therapy for OCD. Previously Tramadol has been used in uncontrolled open-label monotherapy trials in 7 treatment-resistant subjects and has exhibited some improvement so as to earn its status as a potential treatment option for OCD.
The problem lies in using it concomitantly with other SSRIs that are used as first-line treatment in OCD conditions and through its concomitant use with antidepressants like Clomine and Venlafaxine, popular as second-line treatment options for OCD. Tramadol is metabolized in the liver by the CYP2D6 enzymes. The CYP2D6 enzymes are inhibited by SSRIs and serotonergic antidepressants, resulting in Tramadol metabolism and making it stay in the body for a longer time while increasing its blood concentrations significantly. This increases the risk of Serotonin Syndrome with consequences that can hospitalize the user and even prove life-threatening. Additionally, the inhibition of CYP2D6 enzymes by SSRIs and antidepressants compromises the analgesic effects of Tramadol, reducing its effectiveness significantly.
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The important factor that comes in the way of using Tramadol for mental health conditions is the lack of awareness regarding its antidepressant properties. During the evaluation of patient reviews regarding antidepressant advantages of Tramadol, it was observed that physicians’ awareness regarding its off-label use and their willingness to prescribe Tramadol for mental health conditions varied considerably.
Around 29 patients reported the unwillingness of medical practitioners to prescribe Tramadol, while another 18 reported the refusal of medical practitioners to renew Tramadol prescriptions. This can prove a significant roadblock as even after the efficacy of Tramadol for depression, and OCD has been established, not being prescribed will make it extremely difficult for the ones with genuine problems to avail of its therapeutic benefits.
By nature, Tramadol online is a relatively safe medication and preferred over other opioids because of the decreased risk of respiratory depression associated with its use. But it is structurally related to opioids like morphine and codeine and thus has a history of misuse and abuse leading to toxicity. A review on Tramadol toxicity has revealed that medication overuse can affect multiple organ systems and lead to coma and even death of the patient. Treatment with Tramadol should be conducted considering the safe use and dangers associated with the medication. Communication between practitioners and medical consultants is essential to ensure that both sides are satisfied regarding the choice of medication. Most importantly, further research needs to be conducted to explore Tramadol’s potential in mental health conditions.