I have been to 2 very sophisticated advanced pain conferences in the past 2 yrs. Both of them show the central pain circuit in the brain, that these antidepressants are supposed to intercept. This is typically the introduction for the 10hour seminar. This second time this spring, I really paid more attention and still it is a complex concept.

It is complex... very. I think many doctors don't even understand it. (these conferences were mostly doctors attending)

SSRI drugs like Prozac take about 3 weeks to get to the brain.
But the newer SSNI/SSRI combo drugs like Effexor and Cymbalta (they are very similar), are much faster acting.

That Ultram dosage is high. (300mg/day) So you are up there with that drug. The risks are personal and varied.

Personally I think amitriptyline is a better choice. It shows benefits for peripheral neuropathy healing...that no other drug shares. (this is fairly new). But that is only my opinion.