I am seeing my GP tomorrow, I have to go monthly to get my Temgesic medication that I use to treat my RLS. I have suffered with severe RLS for 50 years.
I have been suffering with severe hot flushes for approx 7 months, depression and anxiety for years but it has got worse.
Can you give me some advice please.
What medications can I use to help with depression, anxiety and the hot flushes, that would not make my RLS worse.
Kind regards Julie McGowan from Western Australia.
Sorry Julie, I have no experience of hot flushes.
As regards anxiety depression here is some information -
For BOTH mild to moderate anxiety OR mild to moderate depression the preferred medication (in the UK) is an antidepressant.
If you had just anxiety then an alternative medication may be what used to be referred to as "anxiolytics". The main ones are the benzodiazepines, e.g. valium.
Doctors are reluctant to prescribe these as they can be addictive and can lose efficacy. If they're not reluctant, then I think they're irresponsible. However, you may get people suggesting a benzo who say they have no problem. SAY they have no problem. Some
will say they've been taking one for years. That's another issue.
For severe anxiety, sometimes an anti-psychotic drug may be prescribed. These are derived mainly from sedating antihistamines. They can cause severe RLS related symptoms in people who don't have RLS.
An anxiolytic may help with anxiety, but not depression.
Of you're suffering both anxiety and depression then your best option is an antidepressant.
You will probably get suggestions then about what is a good antidepressant for somebody wuth RLS.
Their suggestions will be based on which drugs that are classified as "antidepressants" are the least likely to make RLS worse.
The typical ones suggested are nefazadone, traxadone and buproprion. Bupropion can actually improve RLS!
However, although these may be "good" in terms of not making RLS worse, it doesn't make them "good" for depression. The first two, actually are used as sedatives, not antidepressants. I've read that buproprion isn't a good antidepressant either.
If you really need an effective medicine for anxiety and depression then there is a RLS Foundation blog that advises either sertraline or citalopram.
They make RLS worse, true., but the depression may take precedence over the RLS.
I believe these should never be taken for more than about 8 months. From experience, citalopram does work and doesn't seem to make RLS worse immediately. By the time it's having a significant impact on RLS, it may be time to wean of it anyway.
I may write more later.
Manerva, what do you know about Cymbalta? My pelvic pain MD wants me to try it, but I am apprehensive to say the least...
It may be good for pelvic pain, but it can make RLS worse.
Thanks Manerva for your reply, I so appreciate the information that you have conveyed. I had so many issues to discuss with my GP during my last appt that I was asked to make another appt to discuss my anxiety and depression. I have an appt this week coming. Meanwhile I am trialing some CBD oil given to me from a friend. Kindest regards Julie McGowan from Western Australia
Julie,don't be too disappointed if the "CBD oil" doesn't work.
"CBD oils", are not a medicine. A medicine is a substance with a fixed known molecular structure so for example Mirapex (pramipexole) has the same molecuar structure as sifrol (pramipexole).
In this sense, there's no such thing as "CBD oil", it's just a label for a wide variety of different products that have (or may NOT have) cannabinoids in them (CBD). There are a lot of these and different products may have different CBDs innthem. Only "full spectrum" has them all.
Hence saying CBD oil is good for RLS is like saying shampoo is good for your hair!
However, how effective any product will be e.g. for helping sleep, also appears to depend on how much THC is also in the product.
CBD oils with a relatively higher THC content seem to be better.
Such oils are NOT legally accessible in the UK, so possibly not in Oz.
I don't wanttodiscourage you fromtryingnit,whoknows,but asIsay don't be disappointed.
CBD oils can be expensive.
Medical cannabis, on the other hand is known to be effective. It's just a matter of managingto get a prescription.
Thanks Manerva, I understand and appreciate what you are saying about the CBD oil.I briefly spoke to my GP about medical CBD oil last week. My GP said she is going to be applying to be licensed to prescribe CBD oil and I will follow that up during my appt this week. I would prefer going through the right channels if I find it useful.
Thanks Julie
It's not just a matter of the right channels, it's a matter of getting the right stuff.
Hi Julie, I can only write about the hot flushes / sweats. I have them too. I had them around menopause and then they eased - until I started taking oxycontin for my RLS. They came back, although slightly different in character. I continued my HRT, as I read in the literature that opioids often lower gonadal hormones, which may very well explain the hot flushes. I have as you may know now stopped the oxycontin and started to take buprenorphine. I hoped the hot flushes would disappear. They didn't. And when I stopped the HRT (for about 4-5 months) they increased in intensity again to the point that was bothering me too much. I have recently re-started the HRT (Tibolon) and the hot flushes have eased to a bearable level.
The effect of opioids on gonadal hormones is mentioned in the latest paper on RLS treatment: mayoclinicproceedings.org/a.... But it does not mention how it can be treated. I found one (or more?) papers that suggested hormonal replacement similar to HRT. But of course, most research jas been done on men and testosterone and no good specific data on women, female hormones or its treatment are available. In sum: mainly my own thinking and experience.
Thank you very much for sharing your own experience with hot flushes.I had my appt with my GP last week but ran out of time and was not able to discuss my hot flushes, anxiety and depression. So I have scheduled another appt for this week.
I know now to make a double appt when I have a list of things to discuss with the GP.
Meanwhile a friend has given me some CBD oil to try.
Kind regards Julie McGowan from Western Australia
Temgesic causes hot flushes. HRT may slightly help but pregabalin is also used for hot flushes and is useful in the treatment of RLS. You could adda small evening dose.Here's the medication leaflet from the US foundation listing the safe anti depressants for RLS.
Some more information..
Here's a link to the RLS foundation blog I previously mentioned
rlsfoundation.blogspot.com/...
It's well accepted that any case of depression should not be treated by drugs alone. Drugs are a short term, stop gap measure to bring symptoms sufficiently under control to allow other measures to be used.
The blog itself refers to three things
1) healthy lifestyle, 2) psychotherapy and 3) pharmacotherapy (drug therapy).
Unfortunately as RLS is chronic, then depresion associated with it can be chronic. I believe this makes it even more important for people to avoid becoming dependent on drugs for their depression as well as being dependent on others for their RLS.
Psychological, cognitive and behavioural interventions for depression may in the long term be more effective for depression than drugs.
They don't make your RLS worse either.
Hi Manerva, thanks for your message and advice. I totally agree, as I do not want to be taking medication for dealing with my anxiety and depression.
I am trying to find other ways of dealing with it. Unfortunately, I have been living a very solitary life for too long, finding it hard now to get out and socialise . Have lost my self esteem and confidence, but I am slowly working on this and making the effort to reach out to others.
My life over the last 12 months has been consumed with medical appts , surgery and recovery. I am trying to find a way back to some sort of normality. I know the things to do to make me feel better in my mind but finding it hard to drive myself. I am sure so many of us with long term RLS are struggling like myself. Thanks Manerva for replying to myself and others, you are so very caring and generous with your time and timely advice in helping others.
Kindest regards Julie McGowan from Western Australia
It does sound as if you've had some difficulties. I appreciate what it's like to through medical appointments and treatments and trying to find a "normal". I'm lucky I'm not on my own which makes it easier.
I nope you do manage to reach out and regain your confidence,
I wish I could help.
Not a medication, but TMS(Neurostar). It worked wonders for my husband. TMS stands for Transcranial Magnetic Stimulation. It is noninvasive and can be curative in many cases. Not sure if it is available in the in Australia.
