Hrm... I can't reply from a parental perspective, so forgive me for that, please. Regarding the medication, if you want to stick with Tramadol for the pain then I can see why you antidepressant options are limited. You can't use an SSRI or SNRI because of the serotonin effect, which only leaves you with tricyclics or possibly tetracyclics (although the latter also affect serotonin levels... just to a lesser degree). The benzodiazepines aren't antidepressants -- they are sedatives and they have the associated problems of both desensitisation and addiction, meaning that you need more to achieve the same effect if they are used constantly. MOAIs are an option, but they require quite strict dietary requirements. If you feel that the chest pains and/or migraines could be more stress related due to the pain then benzodiazepines could be a solution for specific instances, provided they are not used daily, but if you are more concerned with the general depression caused by ongoing pain then tricyclic antidepressants are probably your only option without changing the pain medication. I'm unclear as to whether there is a definite cause for your son's physical pain. Some of the symptoms sound like they could be anxiety/panic-related or psychosomatic, in which case switching gradually to a combined antidepressant such as an SNRI (I'd recommend duloxetine over venlafaxine) or a tetracyclic might be effective alongside a different painkiller. It would be unusual for fibromyalgia to manifest at such a young age so if it's not been specifically diagnosed I wouldn't worry too much about that. As an example of what onmyown was talking about, in my teens I had a lot of pain in my joints because my muscles and bones were growing at different rates and they would "creak" when I bent them and I couldn't put any significant pressure on them. I found exercise that moved the joints without pressure (swimming and cycling, for example) to help. These are just ideas I am throwing out for you to explore (my knowledge lies in neurobiology rather than general physiology, I'm afraid), but maybe some of what we've said will be of use to you. I'm sure it must be very upsetting to worry about your son's health, especially given the situation with school. I hope if nothing else that you can find support here, even if we don't have answers Best wishes and