"i have run through the entire wringer on ssri&#039;s, an maoi, and an snri. lexapro in combination with low dose tramadol has been the most effective duo for me. low dose 100mg once daily tramadol, with intermittent &#039;breaks&#039; (from acclimation to the medicine) has worked well for me over the past 5-6 years in mood stability, energy, motivation, and concentration with no euphoric effects. all of these are very important in my line of work. i do think that an xr formulation might be more useful in stabilizing plasma concentrations and perhaps mitigate some issues with medicine resistance and tendencies to take higher doses (not a good idea). at any rate, use should be monitored. "