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A 68-year-old woman developed serotonin syndrome during concomitant administration of venlafaxine and tramadol [routes not stated]. The woman began receiving extended-release venlafaxine 150mg in June 2009 for anxiety depression. In 2011, she started receiving tramadol 150 mg/day for pain management. During the month that tramadol was started, she developed significant neck stiffness [duration of treatment to reaction onset not clearly stated]. Serotonin syndrome due to an interaction between tramadol and venlafaxine was suspected. Tramadol was withdrawn, and her symptoms resolved within 20 days.