I got my Effexor renewed a few days ago and decided to sit down and read the information pamphlet that came with it. Boy, was I surprised to read that, if I was taking Effexor, I shouldn't take tramadol, Ultram or Ultracet. My doctor had prescribed Ultracet for my breakthrough pain. After researching a bit, I found information that said Effexor and Ultram are similar in structure and taking them both together (I guess on a regular basis), a person could develop "seratonine syndrome". http://tinyurl.com/887sr (copy & paste into address bar) Hmm, makes me wonder if FM and/or CFIDS are syndromes caused (made worse) by the multiple use of medications.