Rls and depression meds

[Mazzi2]

My husband is on sifrol and he also takes antidepressants his sifrol is no longer working his symptoms are worse in more areas and starting earlier.what meds have you been successful with that are ok with antidepressants please

[Hidden]

Although antidepressants can make RLS worse, I think his real problem is the sifrol.

If it's no longer working, worse in more areas and happens earlier then he is suffering from augmentation.

Augmentation is a very common complication of taking any dopamine agonist and sifrol is the worst of these for causing augmentation.

Even if your husband were to stop taking the antidpressant as long as he continues to take the sifrol then the augmentation will continue.

In this case there are several things he should consider doing.

First, ask a doctor for blood tests for setum iron. transferrin, ferritin and haemoglobin. Iron deficiency is a major causative factor in RLS. Even iof his heamoglobin is normal then if his ferritin level is less than 75ug/L then he may beneift from starting on an oral iron supplement. This may help raise his ferritin level to at least 100ug/L at which point, 50% of RLS sufferers gain some benefit.

Here's a link to more information about iron therapy for RLS.

sciencedirect.com/science/a...

Second, and this THE main thing he can do is to wean off the sifrol. This must not be done suddenly, that would be dangerous. It needs to be reduced slowly, the slower the better as reducing the dose of sifrol will cause withdrawal effects. Withdrawal effects usually consist of a temporary worsening of symptoms which often lessen in about 2 weeks. The slower the reduction, the less severe the withdrawls will be.

A ty;pical withdrawal regime is to reduce the sifrol in steps of 0.0625mg (half a 0.125mg tab) every 2 to 4 weeks. i.e. if withdrawals have settled after two weeks then reduce, if not wait up to 4 weeks.

He may have to change his prescription from 0.25mg tabs if he takes these and get some 0.125mg tabs.

If he really struggles with withdrawal effects then if he can get a prescription for an opioid e.g. codeine or tramadol, this will help.

The other thing he should consider is replacing the sifrol with an alternative. NOT with another dopamine agonist. The recommended alternatives to a dopamine agonist are the alpha 2 delta ligands, either pregabalin or gabapentin. These can be taken at the same time as sifrol, but won't be completely effective until the augmentation and withdrawals have subsided. They take about 3 to 4 weeks to start working so shouldn't be started any later than 4 weeks before completely stopping the sifrol.

At one ;point I was taking 0.75mg of pramipexole (generic sifrol) and started taking gabapentin at the same time. I reduced the pramipexole over 10 months and as the dose got lower the augmentation diminished. I now only take gabapentin with good effect.

Here's a link to some information about augmentation

healthunlocked.com/rlsuk/po......

[Mazzi2 in reply to Hidden]

Thank you that great advice I will take all that on board he is augmenting from sifrol and has been for a while it just takes a while to get into to see a specialist and with his depression he doesn't have alot of drive so I have said that's it things need to change his quality of life is not good I'm just trying to o find something he can take successfuly with antidepressants as he has tried a few times to come of those but been unsuccessful

[Hidden in reply to Mazzi2]

I can understand the need for the antidepressants. There are some that are reputed to be less of a problem for RLS.

I only know two. Trazodone is one bupropion another. Infortunately, trazodone has significant side effects and bupropion isn't available everywhere.

I'm not sure where you live so I'm not familiar with your health care system. Your husband may not necessarily have to see a specialist. A primary care doctor may be able to help.

Certainly they can do the blood tests.

If necessary he doesn't need a prescription for iron or vitamin supplements. Over the counter supplements are adequate if taken properly.

The one main factor is the sifrol and reducing that can bring about improvement.