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I was taking Ultram ER with Pamelor and its combined effect considerably reduced my pain.  But, I noticed I was getting dizzy, had a slight headache with a "tightness" in my head and felt ill most of the time.  I happened to check my blood pressure at my pharmacy and I saw it was 210/120.  I went home, checked my blood pressure again with my stethoscope and cuff, and got basically the same reading.  As a trained first responder, I knew this was very serious.  Actually, it scared the crap out of me.  With some basic online research, using a PDR, and talking to some pharmacists, I discovered that tramadol taken with antidepressants, especially those that are norepinephrine re-uptake inhibitors, will cause an increase in blood pressure.  The two drugs should not be taken simultaneously, unless at very, very low doses and under strict medical supervision.  I stopped the Ultram completely and immediately, lowered the Pamelor dose and my blood pressure dropped to 118/87 in a couple of days.  I went through hell stopping the Ultram so abruptly, but I was concerned about having a stroke, so I weathered the storm until I felt better.  Physicians, take notice!