Interested in opinions. RLS for me is a nightly nightmare. Been on Pregabalin up to 300mg. GP said I have depression...

[Davidbaldbloke]

Been on pregabalin starting 75mg and now up to 300mg which seems to work well and helps me sleep a lot. However GP reckons I'm depressed and this could be the reason for lack of sleep and RLS. He has asked me to wean off pregabalin and put me on 50mg of Sertraline which is an anti depressant. Two days in (and reduced pregabalin to 150mg) and sleep has been awful and RLS awful. Sertraline takes upto a month to take full effect. I'm not sure this is the right route as just had two awful nights sleep. Has anyone been down this route? Thank you in advance to all on here who are so helpful and a wonderful resource.

[Kaarina Administrator]

Hi David,

Sertraline is one of the medications to avoid as it can make RLS much worse as you have unfortunately already found out. It is listed in this link Under Medications to Avoid. rls-uk.org/treatment

Wellbutrin (not available in the UK) and Trazodone do not generally worsen RLS. Mirtazapine (Remeron) will worsen RLS for a small minority but not everyone.

[Davidbaldbloke in reply to Kaarina]

Wow, that's really helpful, thank you. I'll contact GP again!! Thank you so much for this.

[LotteM]

Kaarina is right. No need to repeat.

Another issue: dis you mean to say that the pregabalin at 300mg is helping with your RLS and sleep? Since when? I find that when you have found a treatment that works well, it takes time, and a lot of it, to recuperate after many years of bad sleep and restless days due to badly controlled RLS. Maybe that is your situation? Additionally, the pregabalin may be adding to your depression-like feelings. I had that on gabapentin, a very closely related medicine. If so, and if the pregabalin is effective for your RLS, you are faced with a difficult situation. Therapy (CBT) may not be very effective for medicine-induced depression, you may have to add an anti-depressant (see Kaarina's post) or find a different RLS treatment. This time of the year is not helpful either. Get well informed and discuss with your doctor.

[Davidbaldbloke in reply to LotteM]

Thanks. Sorry forgot to reply to this. I'm only mildly depressed but can cope with that. The pregabalin is definitely helping at 300mg. Any less and it didn't seem to do much. I took 300mg of pregabalin last night and had the best night's sleep probably in 5 years - 8 hours!!!!! That makes my mood so much better today. Bad sleep is a big part of feeling a bit down as I haven't slept well in years. Will be taking 300mg tonight again.

[LotteM in reply to Davidbaldbloke]

Good to hear. Keep up the good work. And keep the depression-like symptoms as much at bay as you can. Although the pregabalin may play a part in those. I find a daily walk and generally looking at the upside of things helps.

[Hidden]

Just to add to what others say.

Do you feel depressed?

Furthermore depression doesn't make RLS worse as your GP implies, but sertraline does.

So if you don't feel depressed and the pregabalin works and you sleep a lot, I can't see any reason for decreasing it.

[Davidbaldbloke]

Hi Minerva, I am a little depressed but I would not say seriously. Life has been hard and I am on my own but I keep going ok. Grateful for your comments. I agree sometimes, you just have to take the best route when considering all points. Ideally I don't want to take anything but the nights are horrendous.

[Hidden]

If you are feeling low, then nights are worse. This is especially if you're not sleeping.

Pregabalin may cause a lower mood. However, it also helps you sleep as you seem to have discovered. If you reduce the dose then it will be less helpful with sleeping.

The sertraline may help with your mood, but may make your RLS symptoms worse, especially if you also reduce the pregabalin. This could lead to more trouble sleeping.

In addition sertraline can cause insomnia.

It's a matter of finding a balance.

I understand that it isn't at all desirable to take any medicines, but they may be necessary.

I'd suggest discussing these factors with your GP.

It doesn't seem logical to BOTH reduce the pregabalin AND start sertraline, it seems this may make matters worse, not better.

It's possible that your GP does not know that sertraline makes RLS worse.

[Davidbaldbloke]

So helpful thank you. I would be surprised if my GP does know all that you say. I'm going to print this thread off to discuss this all with him when we speak on Friday.

[Joolsg]

OMG- please don’t take the Sertraline. He’s totally wrong.

RLS can cause depression rather than depression causing RLS .

If the pregabalin works well, stops the RLS and lets you sleep why would he suggest stopping it and switching to a drug that worsens RLS?

Kaarina has included the links that you can show your GP.

[Davidbaldbloke]

Joolsg, thank you for your comment. He seemed to be concerned that I had suggested that I had to move upto 300mg form 75/150/225 and so went down the depression route. He also said Pregabalin is addictive so the sertraline is a safer route! I'm going to stop the sertraline immediately and take 300mg Pregabalin tonight as only got two hours sleep last night - RLS kept me up until 4am. I can't function at all today!

[Hidden]

Such ignorance! Pregabalin is potentially addictive but only if you misuse it. It is prescribed in higher doses than 300mg for other conditions.

Sertraline is not without its problems, it's dependency producing which means if you've been taking it for some time, you can get withdrawal effects when you try and stop it.

I wouldn't show your GP a print out of comments from this forum. It would be all too easy for him/her to dismiss them. We're not doctors.

However, you could print out and show information from the link Kaarina gave.

You could also print out information from the link below

cks.nice.org.uk/topics/rest...

This is the National Institute for Health and Care Excellence (NICE) guidance for prescribing pregabalin for RLS.

Your GP will be unable to dismiss this.

You can also refer him/her to this link

cks.nice.org.uk/topics/rest...

If you click on the "Scenario : management" link on this page you will read it says

"Address any underlying cause -

- An existing drug which may be precipitating or exacerbating etc"

If you go to this link on the same web site

cks.nice.org.uk/topics/rest...

Lower down, you will see -

- "Ask the person about - - - recent medicine use (such as - - - antidepressants)"

Sorry it might seem a bit complicated but this web site contains evidence based infornation published by NICE, a UK national government funded organisation. Your GP would be very foolish to ignore it.

[Davidbaldbloke in reply to Hidden]

Manerva - wow this is all so helpful. Thank you. I took 300mg of pregabalin last night and had the best night's sleep probably in 5 years - 8 hours!!!!! Sometimes you have to weigh up any possible medication risks versus living a miserable life.

[Pindarinda]

Hi David,In addition to former answers and as an encouragement: i also suffered a lot from rls and plmd. The nights were horrible with barely 3 hrs sleep. Once the neurologist said to me to stop taking amitriptyline and citalopram (AD) and instead prescribed pregabaline (now 300 mg) and bupropion (wellbutrin; AD), it was a huge releaf. The wellbutrin is working well and does not worsen rls. Usually i’m able to get 6 hrs of sleep.

Good luck!

[Davidbaldbloke in reply to Pindarinda]

Wow, 6 hours is not bad at all for us RLS sufferers. I took 300mg of pregabalin last night and had the best night's sleep probably in 5 years - 8 hours!!!!! Thank you for your comment and advice!

[Munroist]

Hi David, I have RLS but took pregabalin 300mg for neuropathic pain. My GP described it as a relatively low dose and certainly the effects were moderate both in terms of reducing the neural sensations and the fairly limited side effects. However I found it really helped to have some time where I wasn’t completely obsessed with the symptoms and I’m sure it also helped with associated anxiety and as a result allowed me to re-evaluate where I was and eventually make the decision to come off it in a very steady way over about 4 months. However it was overall a positive experience and I didn’t feel depressed .. in fact the opposite. It did help with the RLS and sleeping and that has got a little worse after coming off but there was no withdrawal or any sign of addiction. In fact despite the reappearance of some symptoms I felt sharper and clearer overall I’m don’t regret coming off it. However if it’s working for you and improving your life I don’t think there is any rush to change that unless you yourself want to do so. Best wishes.

[Davidbaldbloke in reply to Munroist]

That is very encouraging and maybe I can get there after a period of decent sleep with pregabalin. I took 300mg of pregabalin last night and had the best night's sleep probably in 5 years - 8 hours!!!!!

[Munroist in reply to Davidbaldbloke]

Excellent, really pleased. Don't worry if they aren't all the same as different things may affect the intensity of RLS and pregabalin is just trying to damp things down, not remove the issue.

[Domkane]

Ah mate I feel you on this one! I've had depression and RLS since a young age (I'm now 41) and have been prescribed sertraline before. However, it's not just sertraline that antagonises my RLS it's all anti depressants of this class (SSRIs). It's been horrendous. It sounds like your GP might not be clued in to RLS; you say your GP reckons you are depressed? Do you disagree with him/her? It may be that your GP is misdiagnosing your RLS as drpression. Maybe a second opinion is in order?

[Domkane]

Sorry mate...I should have read the other comments on here before posting. My comment is a bit redundant! Anyway, best of luck, I hope you get some relief.

[Davidbaldbloke in reply to Domkane]

No worries but thank you for taking the time to comment. I feel better after last night. I took 300mg of pregabalin last night and had the best night's sleep probably in 5 years - 8 hours!!!!!

[Domkane]

Great news mate! Just one good night can make a huge difference. Take care

[Davidbaldbloke in reply to Domkane]

Thank you! Cannot believe it!