RLS and antidepressants

[Heather-rose]

Hi, I was just wondering if anyone in the UK has been prescribed an antidepressant that doesn’t make their restless legs worse? I’ve been on citalopram, fluoxetine and duloxetine, they have all made my RLS worse.

[SueJohnson]

Wellbutrin and trazodone are both safe.

[Heather-rose in reply to SueJohnson]

thank you

[Pippins2 in reply to Heather-rose]

Wellbutrin isn't available in the UK. I tried Trazadone but the high dose needed for an antidepressant effect (rather than to help with sleep) made me extremely drowsy so I wasn't able to even leave the house let alone drive .I have to take Paroxetine which worsens my RLS and then treat the RLS as I am unable to go without an antidepressant. A catch 22 really x

[ChrisColumbus in reply to Pippins2]

Wellbutrin is a brand name for bupropion. Bupropion is available on prescription in the UK as Zyban, but is generally only now prescribed as an aid to quitting smoking. The NHS says it "is a medicine originally used to treat depression, but it has since been found to help people quit smoking".

I don't know whether any doctors will still prescribe it for depression.

bnf.nice.org.uk/drugs/bupro...

[Pippins2 in reply to ChrisColumbus]

No unfortunately it will only be prescribed very short term for help quitting smoking .As an antidepressant it was pulled during drug trials .I have tried extensively to get it prescribed for depression but no way in the UK .

[ChrisColumbus in reply to Pippins2]

According to Camden & Islington NHS Trust's Guidelines for the Management of Depression August 2021 "Although not included in the current NICE guidance, bupropion may be considered if the other treatment options have failed or are not tolerated. Consultant psychiatrist must be consulted prior to initiation."

[AmyMac5]

My GP wouldn’t prescribe Wellbutrin but agreed to Trazodone and I’ve now been taking it for about 5 months. It’s helped my low mood, not affected my RLS and there’s been none of the side effects I’ve found intolerable on other antidepressants.

I started on 50mg and haven’t tried increasing the dose. My RLS was already well controlled since getting my ferritin up over 100 and taking 2 x 30mg codeine at night.

Interestingly, I’ve been able to drop one of the codeine and still sleep quite well with no RLS breakthrough, though I do wake earlier.

[GaryHB in reply to AmyMac5]

That is so encouraging to hear. Thanks for sharing. I am on Trazadone and Kratom. I might give Codeine a go.

[AmyMac5]

I should add that anxiety was a big part of my need for medication and it has really helped with that. I’ve held off on increasing the dose as there’s improvement and I’m prepared to take it slowly and also give the longer days a chance to lift my mood.

[67Waterman]

Bupropion .... but GP's hate prescribing it because its primary use is not for RLS and (as I understand) there are no clear guidelines as to dosage etc. I got told to go on it by Professor Walker at Queen Square ... but am battling with my GP as he has not been clear about the equivalent dosages of 10mg and 20mg Citalopram.

[NJB71]

hi,

I struggled for a long time with balancing the need for antidepressants and suffering a lifetime of restless legs. I tried Trazadone after coming off Sertraline which had greatly increased the RLS, having already tried Mirtazapine and others. My GP was very patient and spent a long time researching for me. Finally I was given Pregabalin which works extremely well for RLS and is prescribed for anxiety. My RLS is under control and my mood has stabilized.

[Heather-rose in reply to NJB71]

unfortunately pregabalin did nothing for me. I take pramipexole, the dose keeps increasing and I also take codeine and other pain medication. I have to take antihistamines every day which isn’t great for RLS and now I need an antidepressant that isn’t going to aggravate my RLS . It’s a mind field trying to find the right drug combination.

[SueJohnson in reply to Heather-rose]

If you have had to keep increasing your pramipexole, it sounds like you are suffering from augmentation. The signs of augmentation are when you have to keep increasing your dose to get relief, or when your symptoms occur earlier in the day or there is a shorter period of rest or inactivity before symptoms start or when they move to other parts of your body (arms, trunk or face) or when the intensity of your symptoms worsen. If this is the case unfortunately you will need to come off it because it won't get any better. DAs (dopamine agonists) like ropinirole and pramipexole used to be the first-line treatment which is why so many doctors prescribed it but they are not uptodate on the current treatment recommendations. Discuss this with your doctor, but the usual advice is to reduce by .125 mg every 2 weeks or so. You will have increased symptoms. You may need to reduce more slowly or with a smaller amount. Wait until the increased symptoms from each reduction has settled before going to the next one. You will suffer and may need a low dose opioid temporarily to help out with the symptoms especially as you near the end. But in the long run, you will be glad you came off it. Also have you had your ferritin checked? If it is below 100 improving it to 100 or more helps 60% of patients and in some will completely eliminate their symptoms. If you haven't had your ferritin checked, ask your doctor 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. When you get the results, ask for your ferritin and transferrin saturation (TSAT) numbers. If your ferritin is less than 100 or your transferrin saturation is less than 20 ask for an iron infusion to quickly bring it up as this will help your withdrawal.

[SueJohnson in reply to Heather-rose]

Gabapentin or pregabalin are now the first line treatment for RLS. I know you said pregabalin did nothing for you but that may have been because you didn't take enough or were taking at the same time as pramipexole. The beginning dose is usually 300 mg gabapentin (75 mg pregabalin). Start it 3 weeks before you are off pramipexole although it won't be fully effective until you are off it for several weeks. After that increase it by 100 mg (25 mg pregabalin) 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. (You don't need to divide the doses on pregabalin) Most of the side effects of gabapentin or 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 1200 to 1800 mg of gabapentin (200 to 300 mg of pregabalin) daily." If you take magnesium take it at least 3 hours before or after taking gabapentin or pregabalin as it will interfere with the absorption of them and if you take calcium don't take it within 2 hours.

[SueJohnson in reply to Heather-rose]

Meanwhile some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, carbs, foods high in sodium, foods that cause inflammation, ice cream, estrogen, dehydration, MSG, collagen supplements, electrolyte imbalance, melatonin, stress and vigorous exercise. Some things that help some people include caffeine, moderate exercise, weighted blankets, compression socks, elastic bandages, masturbation, magnesium glycinate, low oxalate diet, selenium, 5 minute shower alternating 20 seconds cold water with 10 seconds hot water finishing with hot water for another couple of minutes, hot baths, distractions, applying a topical magnesium lotion or spray, doing a magnesium salts soak, vitamins B1, B3, B6, B12, D3, K2, if deficient, and potassium and copper if deficient, massage including using a massage gun, using a standing desk, listening to music, meditation and yoga.

Many medicines and OTC supplements can make RLS worse. If you are taking any and you list them here, I can tell you if any make RLS symptoms worse and if so may be able to give you a safe substitute.

[GaryHB]

Ive been on Trazadone and it has helped lessen the levels of anxiety which I think helps ease rls. It has not made it worse. The only thing is the side effects which seem to be serious exhaustion. Having said that, everyone is different. Some people dont experience this.

[Eryl]

If you have RLS and depression they are both probably caused by the same thing i.e. inflammation of the nerves (the brain is one big bunch of nerves) caused by the food that you're eating. People like Dr Georgia Ede and Dr Chris Parmer as well as other Phsychiatrists have noted marked reduction in mental conditions from reducing the consumption of refined carbohydrates especially. I have eliminated my RLS without drugs by avoiding inflammatory foods such as refined sugar and refined starch (as in most modern bread) and avoiding refined seed oils which cause oxidative stress and inflammation.