I saw my psychiatrist today who has been trying to treat my adult ADHD (with Ritalin)
As I’ve said in a previous posts he thinks treating my ADHD will treat my RLS (which hasn’t been the case so far after 5 weeks)
In fact, my RLS has seemed worse lately, to an extent, with symptoms kicking in earlier in the evenings, usually whilst sitting in front of the tv. My legs/leg have been twitching earlier in the evening, usually associated with pain in the heel. The symptoms have also been more prominent in my arms… generally on the same side as the leg playing up.
My psychiatrist prescribed me an anti depressant called Quetiapine (Seroquel) that I hadn’t heard of before.
I had told him about my reservations regarding most anti depressants (including SSRIs)
I tried to explain that although this anti depressant may help to promote drowsiness, and sleep, I was worried that (a drowsy state) is usual the cue for RLS symptoms to kick in.
I took a 25mg tablet at 7.45pm and by 9.15pm (getting drowsy) the RLS symptoms in my left leg had kicked in, with the symptoms seeming much more pronounced/worse.
The twitches were more intense (like an electric shot) whilst the pain was greater in my heel. I couldn’t/can’t even stand still.
I’ve taken 200mcg of temgesic (after 9.30pm) in the hopes things might settle down.
Since beginning to write this the symptoms moved to my right leg by 11.15pm although without the strong twitches it would seem.
I’m supposed to take Seroquel for a bit before reporting back to the psychiatrist but this hasn’t been a good start so far.
I get the feeling this anti depressant may be on the no-no list of drugs that worsen RLS.
Is this the case?…
Kind regards CK
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If you look up webmd.com and then look up Seroquel side effects you will see that one of the serious side effects which should be reported to your doctor is restlessness/constant need to move amongst other effects.Because of other medications I was taking I could not take an antidepressant and was given Seroquel. I took one tablet and three hours later I was very drowsy and could hardly say my own name. Needless to say I did not take any more after such an experience.
I have also read that Ritalin should not be used at the same time as opioids.
Your doctor is right that there is a connection betwwen RLS and ADHD but you can affect them without taking drugs. Both conditions are intensified by inflammation of the nerves and you can reduce that inflammation by changing your diet. You need to keep the ammount of carbohydrate that you're eating low, especially processed carbohydrate like sugar and flour (esp. wheat flour) as they have a high GI which means that they are absorbed quickly and will cause a spike in blood sugar. Another cause of inflammation can be refined seed oils like sunflower oil, canola oil etc. I have completeley eliminated my RLS by reducing my inflammation without using drugs.
When I first saw the psychiatrist about my RLS he asked who diagnosed my RLS. I told him my original doctor agreed to this conclusion which was based on what I had told him and also on the 5 criteria for RLS.When I mentioned these he stopped me on the last criteria… ‘that it can’t be explained by any other medical condition’. In other words, he seems to think this criteria has not been answered sufficiently and that ADHD may be the culprit.
I personally believe the key to my problems (both ADHD and RLS) revolves around a lack of dopamine, especially at night.
I tick all the boxes regarding symptoms of dopamine deficiency and the ONLY thing that has had any measurable success in treating my symptoms at night to allow me to sleep is the dopamine rush from an orgasm. (ie: masturbation in the middle of the night after hours of torment)
I mentioned this to my psychiatrist yesterday and that it would be good if there was a tablet that simulates the dopamine rush from an orgasm.
I’m actually concerned that he thinks it’s ‘all in my head’ as every time I show the slightest pessimism towards a drug he’s prescribed he tells my if I think it will happen it will happen… as if I’m no better off taking the medication than a placebo.
He believes if I took Ritalin 3 times a day, from 7am/11am and 3pm my problems would be solved. The problem with this plan is that I’m usually getting to sleep at 3am or later in the morning. I haven’t got up at 7am in the morning for 10 years. So the 3 tablet rule is impossible. Also, taking one tablet around 11am then one tablet at 3pm resulted in insomnia the following night. Even after my RLS finally abated in the early hours I couldn’t sleep still because my mind was buzzing. So I’m afraid I’m not a one size fits all problem.
So he’s trying me on this seroquel. I’m about to take some now but I had a terrible bout of RLS last night an hour after taking it so I’m not particularly optimistic about tonight.
Another drug he said may be an option is Cataprez (Clonopine?) This is another ADHD drug that may or may not help RLS.
Fair enough. As you probably know, there's a high correlation between ADHD and RLS (and other sleep disorders).
Catapres is a brand name for clonidine. Clonidine can be given to people with ADHD who can't take stimulants.
Clonidine does help with sleep, in particular sleep onset latency - in other words, the amount of time it takes to fall asleep. It's not a typical treatment for RLS but has the potential benefit of killing two birds with the one stone (ie treating ADHD and improving sleep). From what i recall reading, it tends to be effective at higher doses (than what has traditionally been given).
Guanfacine is a "new generation" version of clonidine which again is a non-stimulant treatment for ADHD.
The trouble is that stimulants tend to stimulate, whereas people with RLS need the opposite i.e for their brain to be calmed down.
It may be helpful for you to find a neurologist/sleep specialist to treat your RLS or at least give advice on what ADHD medications you can take. And then the neurologist/sleep specialist can liaise with your psychiatrist on this.
Sometimes there's just a gap in knowledge between the different disciplines that unfortunately we as patients need to bridge!
Good reply from Amrob. And remember, a correlation is NOT a causation.
I take ritalin to try to counteract the fatigue/ brain fog from the opioid I take for RLS. Ritalin does nothing for my RLS. And indeed, if taken too late it sometimes keeps my mind too active. On a very low level, but enough to delay sleep onset.
For what it is worth, I think your psychiatrist is wrong and doesn't know enough about (idiopathic) RLS. Difficult to say what to do, except steer clear of the antidepressants as almost all worsen RLS (except Trazodone). I hope you get this solved soon.
I had been trying to see another psychiatrist earlier in the year who had helped someone else by prescribing methadone for their RLS which had been life changing for them.
Unfortunately, his books (the whole clinic’s book actually)… were closed.
I ended up being referred to this current psychiatrist from my relatively new doctor.
Diagnosing me with ADHD has explained a lot of my problems over the years but as I said to him yesterday (and previously)… I can live with ADHD but not with debilitating RLS.
They don’t get it. Unless people experience it themselves they don’t understand the level of suffering that RLS inflicts.
Yes, I’m aware of the correlation between the two disorders. I also read somewhere that clonidine can help people who take a while getting to sleep, which sums me up.
I’ll confess I was more interested in trying this particular drug over the anti-depressant he ultimately prescribed me.
I'm afraid that it has nothing to do with dopamine otherwise sugary foods would reduce both as it induces a release of dopamine but sugar tends to increase ADHD and RLS in most people.
Your doctor obviously knows nothing about RLS since treating ADHD will not stop your RLS. You need to switch doctors. when you see your NEW doctor ask for a full iron panel. Stop taking any iron supplements 48 hours before the test and fast after midnight. Have your test in the morning as that is when your ferritin is lowest. When you get the results, ask for your ferritin and transferrin saturation numbers. You want your ferritin to be over 100. Improving it to that helps 60% of RLS patients. If your ferritin is less than 75 then take 325 mg of ferrous sulfate with 100 mg of vitamin C or some orange juice since that helps its absorption. Take it every other day at least 1 hour before a meal or coffee and at least 2 hours after a meal or coffee since iron is absorbed better on an empty stomach and preferably at night. If you have problems with constipation switch to iron bisglycinate. If your ferritin is between 75 and 100 or if your transferrin saturation is below 20, you probably need an iron infusion since iron isn't absorbed as well above 75. If you take magnesium take it at least 2 hours apart since it interferes with the absorption of iron. Don't take tumeric as it interferes with the absorption of iron. It takes several months for the iron tablets or iron infusion to slowly raise your ferritin. Ask for a new blood test after 8 weeks if you have an iron infusion or after 3 months if you are taking iron tablets. Above all don't let your doctor prescribe a dopamine agonist like ropinirole (requip) or pramipexole (mirapex). They used to be the first line treatment for RLS, but no longer are because of the danger of augmentation. Instead have him prescribe gabapentin. Beginning dose is usually 300 mg gabapentin or 100 mg if you are over the age of 65. It will take 3 weeks to be fully effective. After that increase it by 100 mg every couple of days until you find the dose that works for you. Take it 1-2 hours before bedtime. If you need more than 600 mg take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. If you need more than 1200 mg, take the extra 6 hours before bedtime. Most of the side effects of gabapentin will disappear after a few weeks and the few that don't will usually lessen. Those that remain are usually worth it for the elimination of the RLS symptoms. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin daily." If you take magnesium don't take it within 3 hours of taking gabapentin as it will interfere with the absorption of the gabapentin. Check out the Mayo Clinic Updated Algorithm on RLS which will tell you everything you want to know including about its treatment and refer your doctor to it if needed as many doctors do not know much about RLS or are not uptodate on it at
Hi, it’s been a while since you posted this. I wonder how you’re getting on? Your case sounds similar to mine. I went to see a psych about possible adult ADHD and trialled a dopamine boosting drug, but I had a very unnerving response to it. When it didn’t work as expected, the shrink just wrote me off as a hypochondriac. He had zero understanding of RLS. Or really anything else for that matter. I’ve been on low dose quetiapine for my sleep problems for fifteen years but recently the symptoms of RLS have been so severe I’ve had to rethink my medical regime. Quetiapine is an atypical antipsychotic, not an antidepressant. It calms down some of the catecholemines that are active/misfiring during the night. But it also exacerbates RLS. I recently switched back to my old GP and he agreed to try Buprenorphine. It’s helping, but I’m still struggling with the sleep schedule.
I’m no longer seeing a the psychiatrist as not only was he not helping, but it was costing a fortune.
I stopped all medications he prescribed (Ritalin, Seroquel and later, Clonidine)
I had been taking a small dosage of buprenorphine (200-300mcg temgesic) per night since November last year in various ways (ie: whole tablet, broken up, taking it later after RLS kicked in) but had never had any success with the exception of the first month or so… which was deflating as I was hoping it would be the miracle drug for me
I remember Dr Buchfuhrer replying to an email of mine and has suggested a dose increase may help. I always had to ration my medication as I was only prescribed enough to basically take 1-1+1/2 tablets a night.
About 3 months ago I decided to take more Temgesic (2 tablets under the tongue before bed… then another half later if needed)
This decision has been life saving as I discovered the dose increase reduced my symptoms… Both in bed or before bed if my RLS started earlier.
I still get the odd attack of RLS (sensations/pain in my leg/heel) after going to bed but the extra half or so tablet of temgesic usually settles the sensations relatively quickly within half an hour to an hour at the most allowing me to sleep.
I still have to watch what I eat… no sugar, no alcohol etc but for the last 3/4 months I have almost felt like a normal person. I still get to bed too late (I do shift work and I’m also lazy at getting to bed early) but instead of finally getting to sleep at 5/6/7am in the morning after resorting to masturbation I actually get some sleep during the night. To lie in bed comfortably without the usual terrible sensations and pain (that always forced me out of bed) is truly a blessing.
I’ve been meaning to post again about my positive buprenorphine experience but was waiting to seeing if it was just a temporary thing or whether it was more permanent. There are drawbacks to the medication. Tiredness/grogginess etc getting out of bed and tooth problems caused by dry mouth. There has been quite a few posts lately on this subject. I don’t know if it’s coincidence (I’ve always had tooth problems) but I’ve had quite a lot of problems lately with my teeth. My dentist has suggested using a toothpaste with 10 times the amount of fluoride which Im trialing.
Luckily my doctor agreed to upping my Temgesic prescription to allow for 2+1/2 tablets per night. I haven’t had to increase this so hopefully I’ve found my effective dosage. I’m not on any other regular medication.
At this stage the ADHD/anxiety/depression fix is on hold. But I’ve always said I’m happy to live with ADHD etc as long as I’m getting sleep and my RLS is under control.
Thanks for your response, that’s interesting to hear. I’m also finding that 500 mcg is an effective dose for me, and any more than that makes my throat too dry and yes getting out of bed the following afternoon can be well nigh impossible. I’m sort of enjoying the daytime drowsiness a bit as it’s better than feeling tired but wired. The minimum dose recommended by the experts is 500 mcg and I showed this to my GP who was still ok with this amount. It has allowed me to cut down on the other medications so for the time being, I’ve been taking 12.5 mg quetiapine and 7.5 mg zopiclone. It’s tough waiting until 5 am for the sleep but at least this is not a horrendous amount of medications and they do get me there eventually. Perhaps over time I can work out some other regime. Like you, I’ve tried spreading the dose out a bit. I’m struggling to cope during the day, e.g. getting to appointments etc, as I’m having quite a few right now, so I can’t afford any sleep deprivation.
Regarding the teeth, I haven’t noted any issues yet, but it’s only been about 3 months. Might be an idea to use the fluoride as your dentist is suggesting. I’ll try and remember to bring this up in April when I go there again. I think they have to prescribe the toothpaste? We should definitely discuss this issue here. I do have a fairly positive experience of Buprenorphine otherwise as it definitively suits me better than some of the other common opioids. The only other negative is that it makes me feel a bit low. Have you had that yourself? I’m not sure there is an opioid that wouldn’t cause some depression.
I’m sorry you had to pay for such a useless psych. I have no faith in them (anymore), I believe they are all charlatans - well I always believed it but now I know! Unfortunately the neurologist I went to see last week was the same as they seem to be siding with the psychs a lot. He wouldn’t even listen when I talked about the restless legs and quickly shoved me out the door with a functional diagnosis and a suggestion that nortriptyline might help. Good god.
One more thing, I think iron supplementation is triggering RLS at night. I’ve consistently had a bad night after taking a 50 mg dose in the day time. I’m wondering if anyone else has this problem.
Whereabouts in Australia are you? I'm in Brisbane and yet to find any Dr remotely up to date with rls.
Strike 1 - I was prescribed sifrol 2 years ago from a General Physician when I was having immune system issues. Mentioned I also had rls hence the prescription and slowly but surely started getting worse with being on sifrol.
Strike 2 - I end up going to a sleep clinic and the Dr was only interested in finding out if I had sleep apnea and suggested that's what was causing it. In the mean time he upped my dose to 0.375 and after I said I wasn't wanting to increase he said was solid build and that was a tiny amount anyway. Found this site along with others and realised I was likely augmenting.
Strike 3 - Had terrible Daws symptoms so was referred to a psychiatrist. He said my rls was due to anxiety and that Seroquel was the answer to sleep and anxiety. I knew that wasn't true and did my research but was desperate for the anxiety and dysphoria to stop. Before starting i told him it wasn't recommended for rls but he said to try and if rls gets worse we can stop. I'm on 50mg it does help with sleep a lot and hasn't actually made rls worse. I do find though that my daytime concentration is worse than normal which is what made me interested in your post. My daughter has been diagnosed with adhd and most of the symptoms are very familiar with my childhood and now adult life. I do wonder with the correlation plus recently withdrawing from sifrol that I'm displaying even worse adhd symptoms that I've begun to notice. Concentration is horrendous, I can't listen in meetings procrastinate, takes half an hour to write an email, I typically get by with work from my skills and experience.
Have you reconsidered the non-stimulating medication?
Hi Madillc, are you familiar with the Restless Legs Syndrome Support (Australia and NZ) facebook group? That group maintains a list of knowledgeable health professionals in Australia that deal with RLS (and who members have had positive experiences of).
Although I did notice initially a slight improvement to my adhd on a relatively low dose of Ritalin it wasn’t worth the insomnia at night on top of dealing with my RLS. Plus… in the late afternoon I was noticing a significant drop in my mood as the Ritalin wore off. It was like a wave of depression. The seroquel put my RLS into another gear within an hour of taking it. As soon as I got drowsy the electric jolts to my legs, torso and arms was terrible.
I haven’t reconsidered the clonopine (the non stimulant?) as of yet. Id probably have to go back to the psychiatrist which I’m trying to avoid at this stage.
I was on sifrol for about 5 years up to a maximum dose of .75mg (3 tablets) which really did nothing for my RLS. I don’t know why I was in it for so long but I was still learning about my condition. Had a terrible time culminating in late 2020 getting off it. No sleep and suicidal idiation. After trying just about everything I finally convinced my old doctor to trial 200mcg temgesic per night as if November last year. After initial success the symptoms began to return. He retired in February which left me high and dry and running around the tweed/Gold Coast area (care of Amrob’s list of doctors) trying to find someone who was comfortable prescribing schedule 8 drugs but to no avail. Finally went back to my old clinic and found a lady doctor who, although didn’t no a great deal about RLS, was the first doctor to actual listen to me… and not throw out the evidence I had accrued through the forum. She continued the temgesic on a low dose which wasn’t helping and when I discovered the increase made a difference 4 months ago she was ok with the dosage increase.
Anyway I’m rambling. I can relate to the concentration problems. I take ages to write things… even on a birthday card! I avoid social situations as I either don’t talk at all or you can’t shut me up depending on the conversation. I talk over people. I don’t listen and though I try. I avoid driving as I get so irritated and impatient. I get moody. I could go on all night. But I’ve lived with adhd for almost 50 years now but I’d take it any day over the RLS I’ve suffered through for 10 years.
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