OK, I'm on 30mg of Mirtazapine a day. I have taken MDMA (with reduced effect), Tramadol, and Olanzapine (which I took from a friend, expecting to fall asleep quicker. It didn't seem to affect me). After some reading, I have found that the possibility of Mirtazapine and Tramadol causing serotonin syndrome is possible. Also, Mirtazapine and Olanzapine can cause SS. I also read that SSRIs and Mirtazapine can cause SS. Why does MDMA affect me less than usual? What are the real risks of combining Mirtazapine with Tramadol? None of the combinations I have used have caused me any difficulty. Taking my dose of Mirtazapine causes my pupils to constrict, including after MDMA, which seems odd, as it increases serotonin availability. Does anyone have any answers?