AUGMENTATION HAS ARRIVED

[TEAH35]

As my heading indicates, it would appear that augmentation is now inevitable and has finally arrived.

Because of my bipolar diagnosis several months ago, I was prescribed Seroquel on the lowest dosage possible with prescription instructions to increase it by one tablet each week until I'm taking 8. But my Restless Legs says no way, one tablet is my highest dosage possible, and even with that one tablet my RLS began arriving earlier than usual, kicking in (pardon the intentional pun) at 5 pm. That was ok, I could take my Sifrol early instead of waiting until night time but take no more. However, now on awakening every morning the legs have started to move to the point where another couple of Sifrol are required as a matter of urgency. After throwing a couple down, I'm fine within 10 minutes. It definitely is a game of shuffling around and seeing what works.

Now 5pm comes and goes with no indication of early symptoms, (obviously because of the early morning dose), so I take my night time meds as usual.

Again, all of this is bearable and really not an issue ... but we all know it's only a matter of time until it escalates. My question is, to those of you who have experienced augmentation; how long do I wait until I tell my psychiatrist and we start to work out a coping mechanism for weaning me off Sifrol.

ATM all of this is still bearable and I have no daytime symptoms and nights I sleep soundly (thanks to the Seroquel).

Common sense tells me to advise him immediately, but I guess I'm scared. What if I go on like this for the next few months and intervention is not yet required. Is it a case of the longer I leave it the harder it will be. Common sense sux.

Another question if it's ok, I know that Tramadol is mentioned quite often on this forum as a coping mechanism for augmentation, and luckily for me, my psychiatrist is not against prescribing Tramadol. What other medications have you found to be useful in dealing with augmentation?

[Hidden]

Hi Grany!

Man, sorry about your situation!

I can try and help with your first question because I am in the same boat. From what I have learned about RLS, I am in what is the definition of Augmentation. I have symptom spread and symptoms appear earlier in the day. I totally understand your hesitation about timing in notifying your doctor because things are bearable right now. My symptoms are also bearable (just very annoying), so I hate to put something into motion (a demand to change medication) if things won’t get any worse than they are. But...I am also scared that this will get worse very quickly and I won’t be able to handle it. The reality is that we don’t know what will happen. We don’t know if this will get to the torturous, unbearable stage or if this will just remain at the highly-annoying-but-bearable stage. We. Don’t. Know. Not knowing what the future holds sucks when it comes to this syndrome. My first Augmentation came about very suddenly and got worse very quickly, so the course of action (to get the hell off of Pramipexole) was clear. This Augmentation is taking it’s sweet time, so the course of action is not clear (not even to me). I almost wish this would get to the unbearable part so that I could change to a non-DA and go on my merry way. But, no. I am in a very difficult and complicated situation because this is bearable. Annoying, hell yes, but bearable. Since I can live with this, my doctors are like “ok...so...why fix it if you can live with it?”

I hope that by knowing you are not alone in your confusion and anxiety you are given some peace of mind.

Take care,

Jessica

[Spudellen]

Hi Grany, You are not alone Grany. I hear I have started augmentation too: however, it could be that I am having trouble keeping my Neupro patch on and the last few nights have been murder with RLS. I guess I should be grateful for two whole months of sleep filled nights.

[Hidden]

Hi Grany. Sorry to hear things aren't so good.

I am not so sure what way the seroquel is going to help you without effecting your legs. I know anti depressants can ramp them up well and I would imagine that is possible with drugs of the seroquel type - there are a number of drugs like that you could try. I would be a fan of Largactil, (Chlorpromazine)- its an old drug but imho very effective, and a lowish dose of that MIGHT do.

I was prescribed a number of antidepressants that were murder on my RLS so I feel your pain!!!

You need to talk with the Dr. Because of your Bipolar things are very complicated and you are going to have to work closely with him/her. I augmented when taking Neupro patch, tramadol and Targinact. I came of the Neupro and tramadol and changed my diet and have the RLS well under control, (it had gone completely for a couple of weeks but came back with an antibiotic ).

I think if your psychiatrist is ok with tramadol then use that for the RLS - those sort of drugs are up for abuse but if used correctly for a condition although you may become dependant on them, ( like a diabetic is dependent on insulin injections for example), but you wont get addicted.

In the UK Targinact is also licensed for RLS and it is quite a a potent opiate yet no problems getting it in my experience. I am wondering about the sifrol in the morning - it seems to kick in very quickly and I wonder is there a bit of a placebo effect with it in morning, (not that that is a bad thing I'm all for placebo).

Hope that has been of some help, I really do think you need to work closely with the Dr. I know I bitch on here about Drs being useless and some are but there are also some very good and understanding ones that actually care. You psychiatrist will have more specialised knowledge than your GP and if they are any way decent they will work with you on the RLS.

Good luck and let me know how you get on.

[TEAH35 in reply to Hidden]

Thanks raffs, Sifrol has always worked within 10 minutes so not unusual to me. Woke this morning and nothing. I thought thats right, have a whinge and you're cured. But 15 minutes later I was reaching for the Sifrol

[Hidden in reply to TEAH35]

Thanks for clarifying that about the Sifrol.

When do you meet with the Psychiatrist again? Also what dose of Sifrol are you 1 prescribed and 2 how much and when are you taking it? If you are happy enough to post it what all medications are you taking?

[TEAH35 in reply to Hidden]

Yeah no probs.

Sifrol .... 0.75/ngt

Sifrol .... 0.50/am (new)

Madopar ... 1000/day

Seroquel ... 0.25/ngt

Something else for anxiety 4 tabs/ngt

I have only just seen my psychiatrist this past week. He's great, he's so easy to talk to and really seems to know his stuff. I will make an appointment to see him in the coming weeks. ATM we'll just see what happens. (obviously of interest to you but ... he is soo hot). And yep, it helps ... well doesn't do any harm, put it that way.

My GP finishs up this week so am looking forward to find a new doctor. One that is somewhat sympathetic towards RLS. I will be satisfied just as long as she cares.

[Hidden in reply to TEAH35]

No harm having a bit of eye candy to admire but be careful, ask for too many smear tests and he might get suspicious I'm sorry I tried not to type that but my fingers wouldn't stop

You are on two drugs that act on dopamine and from what I can read it looks like thats a hefty dose of Modopar. If you are augmenting you are going to need to reduce those, slowly and maybe look towards introducing tramadol.

[TEAH35 in reply to Hidden]

I'm all talk raffs, the only communication I've had with my shrink is via Skype. (but you made me smile thanks).

[Hidden in reply to TEAH35]

Tell him his shirt is causing some feedback on your screen and ask that he remove it for the duration of the consult.

[TEAH35 in reply to Hidden]

Seriously speaking (if possible), my personal opinion of this man leads me to believe his reaction would be 'WTF is this old woman on about, she's obviously on too much medication'. Honestly, he comes across as very dedicated, probably over educated (but that's a good thing for me), and has my metal health forefront in his mind. And if that weren't enough, he has a man bun!

Before I moved, the psychiatrist I saw (and this is with face to face consult), seemed distant, uninterested and sometimes even bored. He was the doctor that I was seeing when I was an inpatient, who's job it was to oversee my health while being weaned off Sifrol. Eventually it

became obvious he didn't really give a damn, was totally clueless regarding RLS, treated the condition like so many clinicians do, unimportant and a bit of a joke, with the intention of not replacing Sifrol with anything.

Today I saw my GP for the last time, and after I'd thanked her for her care, I said I understood that forming a good relationship with a new doctor can sometimes be quite difficult but I felt that we had finally got there and she agreed. I said that altho it was difficult in the beginning, I was extremely grateful to her that she stuck in there and got to know me. She goes, 'what do you mean'? I said, 'Oh come on Doc, you thought I was a hypochondriac for the first three or four weeks'. She had a wry smile.

Which is probably a lesson for anyone reading this post (and wondering what the hell we're talking about), altho many doctors don't appreciate restless legs hang in there, keep explaining and don't give up and eventually they will understand and/or, you will wear them down.

[Hidden in reply to TEAH35]

Yeah, my psychiatrist is great as well (when it comes to psychological stuff). Just watch out for yours attempting to include the entire (very physical) syndrome of RLS into psychology.

Good luck with finding a new GP!