There are high serotonin people and low serotonin people.
People with higher levels normally are more sensitive to any drug that raises serotonin in the body. They are typically the ones who cannot stand SSRIs or have long term side effects from them. So adding in Tramadol for them is just more serotonin, if only a little more. These people are thought to be more anxious and more highly mentally aroused than others. They avoid high risk and anxiety activities too. These may be those who get the itching side effect from some synthetic opiates too.
The TCAs don't raise serotonin as fast or as much as the SSRIs and SNRIs. But they do raise it some, and more with increasingly high doses.
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Weezie looking at petunias 8.25.2017
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