The risk of seizures associated with tramadol has been reported. As noted by Drs. Reus and Rawitscher, seizures have been reported when SSRIs (as well as tricyclic antidepressants and other tricyclic compounds, monoamine oxidase inhibitors, opioids, neuroleptics, and other drugs that lower the seizure threshold) are combined with tramadol (1). A nested case-control study by Jick et al. (2) investigated the risk of idiopathic seizures in patients taking tramadol and found that patients receiving tramadol alone did not have an increased risk of seizures. Seizures are also increased in those at otherwise greater risk of convulsive activity (e.g., those with epilepsy, head trauma, or metabolic disorders and those taking other substances that lower the seizure threshold) (1).