trazodone and clomazepam

[NJB71]

Having reluctantly come off sertraline, which worked wonderfully for my depression, because of the horrendous RLS side effects, my GP has now put me on Trazodone as she believes that’s the best antidepressant which won’t cause RLS. I’m only on 50 mg at night to begin with while we see how I get on with it. I’m 72 and apparently there are some concerns foe elderly patients. Because I wasn’t cooing at all well she also put me on 1mg of clomazepam but made clear I couldn’t stay on that for long.

After a week I still have RLS though not as severe. But I am struggling with daytime fatigue. I’m not steady on my feet and feel like a zombie. The clomazepam which I take at night takes ages to kick in but at least I do get some sleep at last. But before it kicks in I get very agitated. I don’t feel my mood is improving. It’s only been 10 days but I’m panicking in case the side effects continue. At the moment I still feel at an all time low.

Should I continue with the medications or just give up? I spend most mornings in tears.

[SueJohnson]

The clonazepam has a long half life of 40 hours which is why you are experiencing daytime fatigue. Better alternatives are ambien or ativan.

[Hidden]

Why exactly were you prescribed clonazepam? Was it for anxiety, RLS, insomnia or something else.And are you taking any other RLS medications?

Too much clonazepam lowers my mood. If I take a quarter tablet (0.125mg) it's fine. I take it for insomnia.

You could try slowly reducing the dose to see if it helps.

[NJB71 in reply to Hidden]

I was prescribed it to tide me over until the trzodone has time to take effect. I was extremely anxious , with low mood, restless legs at night a nd little sleep.

[Typicallygaslit]

I wonder why you felt that antidepressants helped you? You say depression, but are you sure it’s real depression on not just RLS and related sleep deprivation? It’s my personal belief that older people are less likely to tolerate serotonin boosting drugs because serotonin levels go down as you age. Have you considered at all that maybe if the RLS was controlled, the depression might also lift? Agitation is a sign of RLS. In fact, there are lots of ways in which RLS can manifest, not just as kicking legs. Perhaps look into treating the RLS properly first and then seeing if you really need additional medication? I really fear for the side effects for the elderly as I’m heading that way myself. I’m unable to tolerate most drugs because of side effects.

[SueJohnson]

A couple months ago you were prescribed 25 mg of pregabalin. Are you still taking it? As long as you were taking the sertraline, it was unlikely to help, plus it takes 3 weeks to fully kick in and 25 mg is a very low dose. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 200 to 300 mg of pregabalin daily." If you aren't familiar with this Mayo clinic article, check it out at Https://mayoclinicproceedings.org/a... It is the latest guideline on the treatment of RLS.

[NJB71 in reply to SueJohnson]

No, I stopped the pregabalin when I came off the sertraline. That’s when the gp put me on the trazodone, I do still take ferrous fumerate 305 once a day but I think maybe I do need to have my ferritin. Levels checked again.

[NJB71]

I felt that antidepressants helped me be because they did actually help me. My RLS which I’ve suffered pretty much all my life was being well controlled with iron, after discovering my ferritin levels were very low. I was ill in the summer, suffering panic attacks, anxiety and uncontrollable diarrhoea which the GP said was caused by anxiety, the bowel being our second brain . Once the antidepressants kicked in I was much, much better but sadly like many SSRIs RLS was a severe side effect. Hence the need to change the antidepressant.

[SueJohnson]

Also, you mentioned previously that your RLS was under control with iron. Are you still taking it? Have you had your ferritin checked? If so, what was it?

[SueJohnson]

I would suggest trying the pregabalin again. It is the first line treatment for RLS. 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. Beginning dose is usually 75 mg pregabalin. It will take 3 weeks before it is fully effective. After that increase it by25 mg pregabalin every couple of days until you find the dose that works for you. Take it 1 to 2 hours before bedtime. Most of the side effects of pregabalin (and the side effects are NOT increased RLS) 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. If you take magnesium don't take it within 3 hours of taking pregabalin as it will interfere with the absorption of the pregabalin.

[NJB71 in reply to SueJohnson]

thank you. I’ll certainly suggest that to the GP

Is pregabalin a mood stabiliser as well?

[Munroist in reply to NJB71]

I’m not sure what the exact definition of a mood stabiliser is but pregabalin does have some anti-anxiety effects. My own experience was just generally feeling less worried about things and that easing of anxiety eventually allowed me to see my situation in more objective and constructive way.

[Zels in reply to Munroist]

I have read it’s being used off label for insomnia and I found it good for that and possibly my anxiety too. I asked a doctor for it though and she said definitely not as that’s not what it’s meant for. Maybe look for an open minded GP.

[NJB71 in reply to SueJohnson]

you suggested I try pregabalin again. Do you mean as well as the trazodone? On Monday the GP increased my trazodone from 50 to 100 mg at night, and said don’t take the clomazepam, as I felt it wasn’t helping my mood. But i still didn’t sleep, and the RLS was really bad. In desperation I took clomazepam and I eventually got some sleep from about 2am.

Do you advise trazodone plus gabapentin or just tha gabapentin.

My depression is really bad not helped by no sleep and legs which I want to tear apart.

[SueJohnson in reply to NJB71]

Both

[NJB71 in reply to SueJohnson]

Thanks Sue. What dose of pregabelin do you recommend? The GP is going to take me up to 150 mg of trazodone next week, I think.

[SueJohnson in reply to NJB71]

The beginning dose is usually 75 mg pregabalin. it won't be fully effective fr 3 weeks. After that increase it by 25 mg every couple of days until you find the dose that works for you. Take it 1-2 hours before bedtime. Most of the side effects of pregabalin 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 200 to 300 mg of pregabalin daily." If you take magnesium take it at least 3 hours before or after taking pregabalin as it will interfere with the absorption of them.

[NJB71 in reply to SueJohnson]

many thanks

[Birdland]

I haven’t read everyone’s response so I hope I’m not repeating what others have said but in my opinion 1 mg of Clonazepam every night is way too much. I took it for a while at .25 mg per night. Now I take it occasionally at .12 mg. It doesn’t knock me out, just makes it easier to fall back asleep after RLS has woken me. I’m sensitive to medication but 1 mg is a lot.

[NonnieJ in reply to Birdland]

Hi sorry to but in on another person's conversation.

Re Clonazepam..., I take 1 and and a half tablets (strength 500mcg) and often a further quarter tablet when my RLS wakes me in the night. So a total max 1.75 of mcg tablets.

What is that in mg then? Just want to know it's not a massive dose. I do get confused with micrograms and milligrams and grams! Many thanks.

[SueJohnson in reply to NonnieJ]

875 mcg = .875 mg

[NonnieJ in reply to SueJohnson]

is that an acceptable amount or does it sound too much.x

[SueJohnson in reply to NonnieJ]

That's fine unless you are having daytime sleepiness as a result.

[Birdland in reply to NonnieJ]

NonnieJ, I should have clarified my comment. 1 mg is a lot to start out taking before you know how it will effect you. You are taking less than 1 mg. I agree with Sue. If it isn’t giving you any problems then no need to worry. I know someone who takes 2 mg nightly. I still maintain that 1 mg is too much for a doctor to prescribe right out of the gate. All the best to you.

[Suhavard]

Clinical depression is such a specialty along with RLS. You may need a good psychiatrist to help you with the depression, just my opinion. My RLS is normally controlled with 600 mgm Gabapentin and Iron. Plus I try really hard to avoid the meds that can trigger RLS, such as antihistamines. Additionally I take 100mgm of Trazodone to help with sleep. I do have some .5 Clonazepam for break through RLS but rarely need it. I am 70 years old and have suffered with RLS since my teens. This group is awesome. They have so much knowledge.

[Arjiji]

I have been taking Trazodone to sleep for many years, since it is not a very good antidepressant but a good sedative. I started with half a 100 mg pill and I have come to take one and a half (150 mg), because over time the body gets used to it and you have to increase the dose to achieve the same effect. Since I am already 70 years old, I read that it was not advisable to go up to 100 mg, so I reduced the dose to 75 mg again and also took half a Clonazepam 0.5 tablet (that is, 0.25 mg) and that works great for me, I sleep well and no leg pain.

But Clonazepam cannot be taken for a long time in a row, it is a benzodiazepine and tolerance quickly develops (the dose must be increased) and dependence. So one day I take Trazodone 75 mgr, another 0.5 Clonazepam, another 0.50 trazodone+0.25 Clonazepan, and another day I rest and don't take anything. And so I'm keeping the lowest dose and sleeping, except the day I rest when I sleep little and light sleep.

This is my experience.