Based on NIH | Can tramadol cause anxiety, and how common is this side effect?

Tramadol can cause anxiety in some people, and this effect appears in both routine side‑effect listings and clinical trial data. ^[1] Anxiety is reported as an adverse reaction in official prescribing information and consumer drug guides, and it can also appear during withdrawal if tramadol is stopped suddenly. ^{[2] [3]}

How common is anxiety with tramadol?

• Labeled frequency ranges: Anxiety has been recorded in clinical studies at approximately 3–6% of users, depending on the formulation and study population. ^{[4] [5] [6]}
• Immediate‑release vs. extended‑release and combinations: Reported rates vary across product labels, but consistently fall in the low single‑digit percentage range. ^{[4] [7] [8]}

Summary table: Anxiety frequency reported in official labeling

Product/Label context	Reported anxiety rate
Tramadol tablets/capsules (representative label)	4% (vs 3% comparator/placebo) [4]
Tramadol product (another label dataset)	3.1% (vs 1.1% comparator/placebo) [5] [9]
Tramadol product (additional label dataset)	6% (vs 3% comparator/placebo) [6]
Tramadol formulations overview	3–5% across nervous‑system listings [7] [8]

These figures suggest anxiety is an uncommon but recognized side effect, typically affecting a small percentage (about 3–6%) of people in studies included in drug labeling. ^{[4] [5] [6] [7] [8]}

Why can tramadol trigger anxiety?

• Dual mechanism: Tramadol works as a weak opioid and also increases serotonin and norepinephrine (it inhibits their reuptake). This monoamine effect can contribute to nervousness, agitation, and anxiety in susceptible individuals. ^{[10] [11]}
• Interaction risk (serotonin syndrome): If tramadol is taken with other drugs that raise serotonin (such as some antidepressants), a potentially serious reaction called serotonin syndrome can occur, which often includes agitation, restlessness, fast heartbeat, sweating, and anxiety‑like symptoms. ^{[12] [13]}
• Withdrawal component: Stopping tramadol suddenly may cause withdrawal symptoms such as anxiety, sweating, tremor, and trouble sleeping; tapering is usually advised. ^{[3] [14]}

What symptoms should you watch for?

• Typical anxiety/nervousness: Feeling unusually tense, restless, or worried after starting tramadol may be related to the medication. ^[1]
• Red‑flag signs: Fast heartbeat, fever, sweating, muscle twitching, confusion, or seeing/hearing things that are not there can signal a serious reaction and warrant immediate medical attention. ^[15]
• Hypoglycemia‑like symptoms: Tramadol has been associated with low blood sugar in rare cases; nervousness, shakiness, dizziness, and sweating can overlap with anxiety, so any concerning combination should be evaluated. ^[16]

Practical guidance

• Do not stop abruptly: If anxiety becomes bothersome, discuss dose adjustment or gradual taper with a clinician rather than stopping suddenly. Tapering helps reduce withdrawal‑related anxiety. ^{[3] [14]}
• Check other medications: If you use antidepressants, migraine drugs, or other serotonergic agents, review combinations with your clinician to lower the risk of serotonin‑related adverse effects. ^{[12] [13]}
• Seek help promptly for severe symptoms: New or worsening anxiety with signs like rapid heartbeat, fever, sweating, or confusion should be addressed urgently. ^[15]

Takeaway

Based on official drug information, tramadol can cause anxiety, and in clinical trial and label datasets the reported frequency is generally in the low single digits (around 3–6%). ^{[4] [5] [6] [7] [8]} Anxiety can also appear during withdrawal if tramadol is stopped quickly, and serious serotonin‑related reactions are possible when combined with other serotonergic medications. ^{[3] [14] [12] [13]}