Mrs. Kelly White, a 30-year-old female, is taking sertraline 100 mg daily for depression. Her family doctor has recently prescribed tramadol 50 mg twice daily for chronic back pain. What is the most critical adverse effect that Mrs. White should be counselled to monitor for with this combination?

Question: Mrs. Kelly White, a 30-year-old female, is taking sertraline 100 mg daily for depression. Her family doctor has recently prescribed tramadol 50 mg twice daily for chronic back pain. What is the most critical adverse effect that Mrs. White should be counselled to monitor for with this combination?

Answer options:

• Increased risk of G.I. bleeding.
• Potential for severe constipation. ✅ Symptoms of serotonin syndrome.
• Exacerbation of her depression.

Correct answer: Symptoms of serotonin syndrome.

Explanation: Both sertraline (an SSRI) and tramadol (which has serotonergic activity via reuptake inhibition of norepinephrine and serotonin) increase central serotonin levels. The concomitant use of these medications significantly increases the risk of serotonin syndrome, which can range from mild (tremor, anxiety) to severe (hyperthermia, clonus, mental status change).