I had no problem, but have low serotonin. The other issue is what
dose the Ultram is
. That makes a huge difference, as well as the Effexor dose. 37.5, 75, or 150? And is the Ultram XR, or regular. If you're uncomfortable, your doctor could also check once a month - on your levels. They're both good drugs, so I hope you can get good guidance from your physician and pharmacist.