Sertraline and RLS

[Bruxelles]

Hi everybody,

My Dr.has prescribed Sertraline for depression. However, I have read that this makes RLS worse. Is there an anti-depressant which doesn’t affect RLS does anyone know please. Wish you all some sleep tonight. Nite nite

[SueJohnson]

Ask for wellbutrin. It is not only safe for RLS but There are even anecdotal case reports for it relieving RLS symptoms. If you can't get that one ask for trazodone.

[Bruxelles in reply to SueJohnson]

Hi Sue,Thankyou for your reply.

I didn’t get to the Dr. until yesterday. My Dr. Was away and I saw a replacement Dr., very unsympathetic and was quite difficult about giving me antidepressants. She said she knew all about RLS and I explained to her why I didn’t want to take Setraline. She has prescribed Mirtazapine which I have to collect from the pharmacy. The Mirtazapine is an antagonist of the receptors of adrenaline and serotogenique. I am wondering if this has a similar action to Sertraline which is classed differently as an I SRS but it’s action is “inhibitor of the recapture of Sserotonine.

Do you have any idea about this please?

I hope you have had some sleep!

Have a nice day

[SueJohnson in reply to Bruxelles]

Mirtazapine is actually worse than Setraline. Mirtazapine has a 28% chance of worsening RLS symptoms whereas Setraline has a 9% chance of worsening RLS symptoms. She wouldn't prescribe trazodone? Others that are safe are Norpramin and Stablon.

[Bruxelles in reply to SueJohnson]

Hello again,

Thankyou so much for info.

I wish I’d waited a bit longer as I went up to the pharmacy and asked (they had ordered it for me and I’d paid for it) told the pharmacist what I told you and asked her if the Mirtizapine acted in the same way as Sertraline because of the RLS. She Is the main pharmacist (not the one I saw yesterday who I’ve never seen before) and knows about my RLS and my history because I have been going there for years. She herself had rls for a short while.

She just looked on her computer at the side effects of Mirtizapine and said all the antidepressants had more or less the same side effects and that Mirtizapine was not very strong and I could stop it if it was a problem for my legs. I kept insisting about the Serotonin inhibitors and said they weren’t all the same as some recapture noradrenaline and others have other actions, etc.etc. She said it was complicated for them to understand let alone the public! So very unhelpful! I ended up by accepting them thinking I would try them but now having read your reply I think I’ll put them in the bin. I should have waited but wanted to get out and thought I might not hear from you for some time. Oh well I’ll just struggle on. I can’t afford to pay another Dr. and more meds, particularly if they won’t give me what I need. (I live in Belgium so it’s not free). Trazadone is classed in the same group as Mirtizapine in my reference book. Norpralin and Stablon aren’t listed. I guess those are the trade names and have another name here.h

[SueJohnson in reply to Bruxelles]

Norpramin's other name is desipramine , Stablon's other names are tianeptine and Coaxil. I'm not sure what you mean by "Trazodone is classed in the same group as Mirtazapine in my reference book." The Mirtazapine may not cause you any problems as everyone is different. Try it and see.

[Bruxelles in reply to SueJohnson]

None of those names are in my repertoire so either they aren’t sold here or are under some other name.The antidepressants are grouped into catagories by the way they act - I can’t translate these exactly from French but it’s about whether they influence serotonin, noradrenaline, dopamine, neuro récepteurs, association of two of these, tricyclique, etc. All very complicated! As you say maybe try it and see!

I hope you have some sleep tonight. Are you from U.K.? Is your RLS under control now?

[SueJohnson in reply to Bruxelles]

I live in the US and my RLS is completely under control with 1500 mg of gabapentin.

[9642birss]

My RLS was pretty much under control with Alprazolam. Very small dose. Doctor switched to Sertraline and it really got worse. Tossed out the Sertraline (and doctor) and am trying to get by with OTC.

[SueJohnson in reply to 9642birss]

If it is only "pretty much under control" have you tried gabapentin? Have you had your ferritin checked? Improving it to 100 or more helps 60% of patients and in some completely eliminates their RLS symptoms.

[9642birss in reply to SueJohnson]

After the Sertraline, my (ex) doctor tried the Gabapentin, Same bad results. Right now I take OTC "Rested Legs" plus a bit of iron & magnesium. Not doing too bad.

[SueJohnson in reply to 9642birss]

The OTC Hylands Restless Legs worked for me for a couple months but then stopped. On the gabapentin are you saying that your RLS symptoms increased while you were on gabapentin?

[9642birss in reply to SueJohnson]

Didn't increase. Just didn't get better. I was on a really small dose of Alprazolam for 30 years. Only .5mg each evening. No RLS problem. Then wacko doctor decided I was "Addicted" and stopped my prescription. Tried the Sertraline and Gabapentin without good results and then was told to quit dairy, eggs and meat. This from a MD from Hawaii where the favorite breakfast is a Spam and cheese omelet. Anyway, my new doctor would probably renew my Alprazolam if I wanted to, but I think I'll just stick with the Rested Legs, iron and magnesium for now.

[SueJohnson in reply to 9642birss]

Often times people give up on gabapentin thinking it doesn't help when they aren't taking enough of it. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin daily." By all means continue on the Hylands Restless Legs, iron and magnesium, but at a later date if they no longer work, consider going back on gabapentin. I assume you know to take magnesium at least 2 hours apart from the iron since it interferes with the absorption of iron.

[9642birss in reply to SueJohnson]

Thanks. My RX for the Gabapentin was for 100mg up to 300mg two hours before bedtime. Guess my ex-doctor wasn't too familiar with this product.Lost a lot of faith in the medical establishment lately! I take the iron supplement in the morning and magnesium at night.

[1brightongirl]

I've been on Wellbutrin for 10+ years and had never had RLS. But 3 months ago I started Sertraline and about 5 weeks later I had RLS for the first time. I managed to stay on it for another 5 weeks but couldn't handle the RLS and stopped it. Since then, after about 3 weeks of no Sertraline, the RLS has improved, i.e. less intense and not as frequently occurring, but has not gone.

[SueJohnson in reply to 1brightongirl]

Are you taking any medicine for your RLS?

[1brightongirl in reply to SueJohnson]

No, I wanted to see if stopping the Sertraline would stop the RLS. I'd say there's a 70% improvement after 4 weeks off it. Keeping fingers crossed!

[SueJohnson in reply to 1brightongirl]

I'll keep my fingers crossed for you too. But if it doesn't get any better, ask your doctor for gabapentin. Don't let your doctor prescribe a dopamine agonist like ropinirole (requip) or pramipexole (mirapex) as up to 70% of people will eventually augment on them, which believe me you don't want because it can be hell to come off it Check out the Mayo Clinic Updated Algorithm on RLS which discusses the latest guidelines on RLS treatment.

Https://mayoclinicproceedings.org/a... . Also, have you had your ferritin tested? If so what was it? Increasing it to 100 or more reduces symptoms in 60% of people. If you take any other medicines or over the counter supplements, if you list them here I can tell you if any of them are likely to exacerbate symptoms and can perhaps give you a safe substitute.

[1brightongirl in reply to SueJohnson]

Yes I did get my iron checked a few weeks ago after reading about iron deficiency and RLS on this site. My Ferritin was only 17 and % sat only 14! The response from my doctor was a message via her assistant to take a multi-vitamin with iron. I asked what dose, what type of iron etc?... The response was that any over the counter supplement would do.

It's a long story but I was very frustrated and angry with this casual brush off considering I was reading that some doctors will even refer RLS patients for iron infusions if Ferritin is lower than 100! I decided to do my own research and started taking 36 mg iron bisglycinate along with 1000mg vitamin C on an empty stomach - avoiding certain foods, tea/coffee, PPI's etc. - all the stuff that's advised online. (All the stuff that my doctor couldn't be bothered to tell me about.)

In addition, I found a neurologist that treats RLS and who took me seriously. He looked at my blood work and told me to take the iron/vit c twice a day and he's checking my blood again in 3 weeks. If there's no improvement, he's willing to do what it takes to get my numbers up and have me feeling better. (I have other symptoms besides the RLS.) I feel so relieved to have someone who's actually in my corner now!

I advise anyone who gets the brush off from their doctor, and is really suffering - from any condition physical or mental, to do their own research while looking for another doctor. If you don't feel you have the strength to do any of this, try to enlist the help of a family member or friend. When I feel I can't handle a phone call to my insurance company or doctor's office, my spouse takes over and is my biggest advocate.

So whether it's the iron, the sertraline or a combination of both, I'm in battle mode and feel optimistic!

[SueJohnson in reply to 1brightongirl]

I'm glad you found a doctor who took you seriously. Unbelievable how bad doctors who think they know it all can be. Yes the guideline is to have an iron infusion if your transferritin saturation is below 20% and also to look for the cause. Once you get the transferritin saturation above 20% then the guideline is iron tablets until your ferritin is 75 and then iron infusions again since the iron is not absorbed as readily above 75, but you probably know this from your research. On the vitamin C, 100 -250 mg is enough.