Well, so much progress. My question. Have any of you experienced Sertraline as a cause of PLM?
I am currently on Pramiprexolex4 (.125MG) daily. The gut feeling is that this medicn has stopped PLM (had for last 6 years- bcos I was on sertraline). Is it likely the doc will now withdraw Pramiprexole?
It's well accepted that SSRI antidepressants, like sertraline can exacerbate RLS/PLMD.
In which case, withdrawiung the sertraline could lead to some improvement in the RLS/PLMD.
However, I don't believe that sertraline causes PLMD, it just makes a pre-existing condition worse.
It's not good to be taking pramipexole so you may try reducing it and even stopping it to see what your PLMD is like without it.
Note that you may experience some withdrawal effects when reducing it so it may be a while before you find out if you can manage without it.
Also recall the previous suggestions you were givden about iron.
I was on the antidepressant imipramine. The RLS and PLMD started about 3 years after. I have been off antidepressants since 2013 and have been taking primipexol since 2010. I would like to get off the primipexol but I don't know of anything else that could help with symptoms. When I tried to go without primipexol, the RLS and PLMD went mad! They didn't stop for four days. I went back on them as I felt I had no choice. When I stopped taking antidepressants I did not experience improvement and remained on primipexol. It is my opinion the damage was already done. I feel antidepressants were the cause of my disorders.
You can get off pramipexole if you do it very slowly over a minimum of 3 months. It’s very difficult but many of us have done it and are in a better place.
There are other drugs that are better like pregabalin/Gabapentin or low dose opioids.
I tend to agree that some people do experience permanent damage/ down regulation of dopamine receptors after anti depressants- many people report that their RLS/PLMD has been triggered by ADs.
I am replying in Jools box but am so grateful to all three Roxy and Manerva, (bet there's some medical training in at least one of these replies). Although I have no proof, because I cannot see myself asleep, I believe my PLMD has stopped with this Pramiprexole. No kicking of radiators etc. Sleep seems calmer, and fuller. I fall asleep almost instantly, and wake up about 4.00 to spend a penny. Straight back to sleep after that, which is great as I have a little phobia on going to sleep.
The withdrawal symptoms are "interesting", I did anticipate though shouldn't be a problem.
Will be consulting with GP in a week, but curious as to whether she will offer a slow withdrawal.
What muddies the water is when PLMD and RLS are a merged topic. They are similar in symptom, but should the treatments be the same? Do you get where I'm coming from? Anyway cross fingers to what she says, but I still very much value your input greatly.
Spurdog- can I just check you’re on 0.125 of
Pramipexole? You have typed 4 after pramipexole so are you on 1 pill or 4?
Your GP will not be aware of the full trauma of pramipexole withdrawal so be wary.
The slower you reduce, the easier it will be.
It can take some months for RLS/PLMD symptoms to settle & then you may discover whether your RLS/PLMD has disappeared.
The treatment of both conditions is the same.
4 a night of .125
Oh dear. That is not good.
The top experts recommend a maximum of 1 x .125.
High doses are more likely to lead to augmentation so read all you can about it and DO NOT increase the dose when it stops working.
I’ve attached a link- be aware so you will know what to do.
It has always been a bit unclear the quantity as the labelling doesn't tie in. So, the Pramiprexole box is .088MG, 30 tablets. The label refers to .125MG, however agrees .088 MG pramiprexole. In other words there is something else in the pill to make it up to .125MG.
I know but 4 pills is still too high. Top experts will only prescribe 1 x 0.088mg of pramipexole and advise stopping the minute it no longer works. The risk of Augmentation is too high and it’s hellish to get off that high a dose. I hope augmentation is a long way off- make sure your ferritin is above 100 as there is anecdotal evidence that this can reduce the augmentation risk.
When I stayed in hospital my RLS didn't appear. At the time I was disappointed because I wanted doctors to see how bad it is. I felt as though I had a good sleep while there. When speaking to the nurse who had watched my sleep video I explained that I had a good sleep. She said I never stopped moving all night. This is the PLMD, because I sleep through it I wasn't really aware of the true effects.
My uncle has recently retired from the military. He too has been diagnosed with RLS and PLMD. Also on primipexol until recently. He has used marijuana to control symptoms and get off primipexol. I had never been a marijuana user but a friend owns a dispensary so I was able to sample different strains. I finally found a strain that helps. More often than not if my symptoms start up I can get immediate relief from the marijuana. This strain is called Grand Daddy purple. The only downside is it doesn't last throughout the night. I found a dispensary that is going to provide me with a capsule form to see if it has a more lasting effect. Because my system is now used to the marijuana I no longer get the effects of being high, it just stops the symptoms.
I hope you can find some relief. I know for me I get comfort from this group and knowing that I am not alone in dealing with this illness.
Thanks for the point Roxy. I hope i would now know because i have no broken toes. My bed is against the wall. LOL
I think it is possible to have a side effect from another medicine eg sertraline might cause PLMD while taking it. I don’t think it has to pre-exist & therefore only worsen. But plmd/RLS is a very odd condition as we all know so permanent altering of dopamine receptors is possible ( I believe it has happened to me taking pregabalin ). Treating a side effect with another treatment is never wise unless the original treatment is essential. The original treatment should be stopped instead. I would definitely cut down your DA now but as others have said this is going to need to take a long time & will likely be a rocky road & only after this will you know what you are left with.
Yes I had awful PLMD on Sertraline, stopped when I came off it.
Embroiderer, you have shown my point. I came off sertraline and the PLMD appears to have stopped, and yes a wait of afew months for it to completely clear the system. It appears that i am also right, PLMD and RLS are recognised as two slightly different things, (and my heart goes out to any RLS sufferer, and indeed Parkinsons). Though for the benefit they are grouped on here.
Incidentally my wife has had to use Gabapentin, but she felt it was affecting her mind and she was losing concentration with it.
I get RLS too, which has continued, but the PLMD, which was while awake, was horrible, and has pretty much stopped since coming off Sertraline.
I was on Sertraline for 2 months, prior to that was on Paroxetine and Mirtazapine and they all made my RLS 100 times worse. I’ve been off Sertraline for 6 weeks now and am still feeling the side effects. I had horrific muscle twitching in my legs along with the RLS so went to see a neurologist who said I had RLS and PLMD which have been exacerbated by the SSRI medications. I still have the twitching but to a slightly lesser extent and still bothered by RLS throughout the day and night. I am hoping with time it will settle, hope yours does too.
Absolutely! No doubt in my mind that Sertraline (and other SSRI’s/agents (like opioid discontinuation - see PuBMed acrticle 50% patients develop RLS)) can not only exacerbate but, cause, RLS and/or PLMD. I have a large collection of peer-reviewed medical studies that back this up, without any doubt. “Antidepressant Discontinuation or Withrawal Syndrome (AWS)” (wiki it) is a well-established though largely unrecognized syndrome and includes symptoms including movement disorders. These usually resolve within days or weeks but some have ongoing problems long-term. Risk factors include abrupt SSRI/agent discontinuation, length of use and the agents half-life (shorter is higher risk). In the case of Sertraline, it has a short half-life and more importantly, it’s the only antidepressant with direct affinity for the dopaminergic system - specifically, the Dopamine Active Transporter or DAT (PubMed search “Sertraline DAT”). So, there is a direct link.
In my case, I took Sertraline (Zoloft) at 150mg for 4 months in 2003 for dysthymia. I had no previous symptoms of PLMD or excessive PLMS at any time in my life or while taking it and slept well in general though was having more daytime lethargy in the past 1-2 years. My wife never complained about excessive movements. I video taped myself several times before starting Sertraline to find out if there might be something negatively affecting my sleep. No excessive movements seen but lots of snoring (later ended up on CPAP).
On doctor’s orders as it wasn’t helping with my mood at all, I discontinued Sertraline over 4 days. 2 days after my last dose I had 2-3 large involuntary leg movements while awake relaxing which felt like electricity building up over 3-4 seconds (like on a dimmer switch) then BAM!….quick leg muscle contraction for 2-3 seconds, then relax. They really freaked me out. That night, the PLMD blew up. I couldn’t get to sleep because my legs - foot towards knee, knee towards chest, foot pointing down - were moving involuntarily every 15-40 seconds. It was bizarre! I didn’t get to sleep for 3 hours….until I had tired myself out. Next day they occurred every time I sat or lied down to relax, as I tried to sleep (the worst time) and sporadically through the night, based on video taping. I estimated several hundred with at least 100 resulting in arousals (which are NOT a measure of sleep quality as PLMS can prevent REM and N3 sleep without arousals).
My daytime lethargy went from mild to severe. I had to go from full to part-time work. Within the next several months, I was newly diagnosed with anxiety (akathisia actually) bruxism, GERD, dizziness, vision disturbances, brain “zaps”, gastrointestinal problems, headaches and then, Major Depression. These are all symptoms of AWS and some, like bruxism (teeth grinding), are tied directly to Sertraline in several studies. In late 2003, I had my first sleep study. Over 700 PLMS and 155 arousals. “0%” REM sleep and “0% N3. 3 subsequent sleep studies show the same pattern even though my CPAP therapy is effective.
19 years later, despite seeing many physicians, trying all kinds of medications, either alone or in combination, my PLMD is still only moderately controlled (I still have hundreds of movements at night, none during the day) and I take 5 different medications, most of which I believe are only effective because of their sedative properties (i.e. reducing my bodies reaction to the invol. movements rather than having a direct impact on the cause itself. I can’t work consistently. I sleep 12-18hrs/day. Most effective med combination has been 2mg Clonazapam, 4mg Requip and 50mg Oxycotin at bedtime. However, now with the opioid epidemic, it’s difficult to find a doctor who will prescribe these meds together especially on CPAP. Plus, with my experience, tolerance has been a major obstacle. When I first took Clonazapam, Pregabalin, Requip, and opioids I felt I was “cured”. But, whether it’s 2 weeks, 2 months or 2 years, tolerance/habituation always occurs and I need something new - hence the 5 medications. In addition, I’ve found that tapering off these medications leads to increased symptoms which increase depression and daytime lethargy.
Based on the suspicion of tolerance, my doctor has finally agreed to try rotating mono-therapy in which I take 1 medication for, say 10 days, switch to another, then another and another and then start over by which time the first medication is “like new’ as far as my brain is concerned. I plan to do all of this in an inpatient setting where I can have the withdrawal from current medications medically managed, sleep/PLMD monitored and treatments evaluated in real-time. Deep Brain Stimulation, ECT and, most risky, brain ablation (destroying part of brain that is the epicenter, if it can be found with high certainty) are possibilities. At this point, some loss of motor functioning and little-to-no PLMD would be better for my quality of life.
Mine has been a severe case from the start. I don’t think someone’s severity level worsens over time though my movements have gradually moved from. My legs up to my torso, arms and shoulders. Hope you’re faring better. Please feel free to PM me.
Recommendations: Don’t begin any SSRI’s unless absolutely necessary and if you do take them, taper off very, vert slowly e.g. with Sertraline : 25mg every 10 days > 2 weeks.
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