I have just read a small Turkish study on the use of Vortioxetine for depression and anxiety in 7 RLS patients. It states that it helped the RLS patients and didn't worsen their RLS. For some reason, I can't copy the link on my phone. It's by the department of neurology at Ankara University in Turkey.However, only one of the study participants was RLS drug naive. The others were all on Pramipexole AND gabapentin, leading me to think that thet are probably all suffering augmentation. Otherwise, why add gabapentin?
I thought I would mention it in case there is anyone suffering from depression and anxiety who cannot get or does not respond to trazodone or wellbutrin.
It may be worth a short trial to see if it helps depression and anxiety without triggering/worsening RLS.
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Joolsg
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Yes, I know. That's another reason why the study is problematic. Only one, drug naive person responded well. It's too small a study to take seriously and all patients, except one, were on Pramipexole.They tried Vortioxetine because they knew other SSRIs triggered RLS. I've written to the study authors pointing out that 6 of the 7 study patients were on Pramipexole AND gabapentin so were most likely suffering augmentation. Only one was drug naive and she didn't experience a worsening of RLS on Vortioxetine.It would be very difficult to ascertain whether the other 6 experienced a worsening because they are all highly likely to be in augmentation.
The study authors are all neurologists at Ankara University. I suspect Turkey still prescribes dopamine agonists as first line treatment, like the rest of the world.
Hi Joolsg. In response to your question to me about Pramipexole: My original idea was that Pramipexole (which I have never taken) and similar medicines sometimes cause the liver to overproduce oxalic acid which is the root cause of RLS. I now believe it is the fluoride in the medicines which triggers the production of excess oxalic acid. I and many others got relief of discomforts by following a low oxalate diet after my original perception that I could turn RLS discomforts on and off by controlling the amount of oxalate I ate. In recent years I have reduced my fluoride exposure in all its forms: in city water, pesticides, non-stick cookware, commercial beverages, wine and tea. I have also avoided eating any refined, bleached and deodorized cooking oils made from seeds (corn, soy, canola, etc.) because I believe they stress the liver and make it vulnerable to fluoride’s toxicity. I eat “grass fed” butter, unrefined coconut oil and extra virgin olive oil. After several years on this regimen I no longer have RLS and I no longer have to eat a low oxalate diet. Spinach and sweet potatoes are currently my most frequently eaten vegetables.
2023; 21(3): 599-603 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE
Potential Effect of Vortioxetine on Restless Leg Syndrome
Abstract
Restless legs syndrome (RLS) is a chronic progressive movement disorder characterized by abnormal sensations, especially at rest and at night, as the need and urge to move the lower extremity. It has been reported that RLS severity and frequency increase in patients with anxiety and depression. It has been reported that serotonin-noradrenaline reuptake inhibitors such as venlafaxine and selective serotonin reuptake inhibitors such as citalopram, fluoxetine, paroxetine, and sertraline can cause RLS symptoms. No adverse effects of vortioxetine on RLS have been reported in the literature. In this case series, we report the effect of vortioxetine in patients with RLS with symptoms of depression and anxiety. In this case series, the effect of adding vortioxetine to treatment on RLS symptoms is reported in 7 patients (5 female). After the use of vortioxetine, 5 of 7 patients’ symptoms regressed without the need to start a separate drug for primary movement disorder. In conclusion, we believe that studies should be conducted to investigate the efficacy of vortioxetine in the treatment of RLS. Therefore, randomized controlled studies are needed to determine the effect and safety of vortioxetine on RLS symptoms.
DISCUSSION
After the use of vortioxetine, 5 of 7 patients’ symptoms regressed without the need to start a separate drug for primary movement disorder. It is known that depression and anxiety increase RLS symptoms [3,13,14,16]. In a study comparing more than 2,000 participants in the normal population with 130 patients diagnosed with RLS, a strong relationship was identified between RLS and anxiety disorders (odds ratio = 3.5; 95% confidence interval 1.7−7.1). In a population-based study, patients with RLS exhibited greater anxiety and depression symptoms than control subjects [3]. However, it has been reported that many antidepressants may cause RLS as a side effect. Therefore, psychiatric treatment of patients with depression and anxiety accompanied by RLS a clinical problem.
Vortioxetine is an antidepressant that has recently entered our clinical practice [17]. It has a different and more complex mechanism of action than other antidepressants [17]. Like traditional selective serotonin reuptake inhibitors, it can increase serotonin levels through inhibition of serotonin transporters (SERTs). However, its action on various subtypes of 5HT receptors gives vortioxetine its unique characteristics; Its effect on dopamine, Gaba-aminobuturic acid, Noradrenaline and Acetylcholine has made it accepted as a multimodal antidepressant [17-20]. In animal studies, it has been shown to increase dopamine and noradrenaline, especially in the prefrontal cortex and ventral hippo-campus. Findings of studies showing that the drug causes improvement in cognitive functions and low sexual side effects support the increase in dopamine [17,21-23].
The results of animal models of RLS and biochemical, postmortem, and imaging studies in patients with the disease suggest that disruptions in brain iron trafficking lead to disturbances in striatal dopamine neurotransmission [24]. Previous studies have shown that L-dopa can relieve the symptoms by 50% in approximately 90% of patients [25]. For this reason, pramipexole and ropinirole, which act as dopamine agonists, are among the most commonly used treatment options [26,27]. However, recently, considering the risk of long-term dopamine augmentation, there has been an increased interest in gabapentinoids, which are known to be effective by improving somatosensory symptoms on the RLS. Gabapentin and pregabalin has become one of the first-line treatment options [28,29] Considering the efficacy of vortioxetine on both dopamine and gaba , its may have had a positive effect on RLS symptoms.
Two patients’ symptoms resolved completely, and one of whose symptoms did not return despite discontinuing pramipexole treatment. Based on the improvement in this case series, it can be thought that vortioxetine is a candidate to be a reliable agent for the treatment of depression and anxiety accompanied by RLS. In a case report in the literature, an increase in RLS symptoms was found after escitalopram was used for major depression. In this case, with the switch to vortioxetine, both the RLS symptoms of the patient improved and her depression was treated. The fact that the RLS symptoms of the cases decreased may be secondary to the treatment of anxiety and depression. However, in one of our cases, the patient was diagnosed with RLS in a detailed anamnesis after he applied to the psychiatry clinic with depressive symptoms. After the vortioxetine treatment, her depressive and RLS symptoms decreased. Taken together, vortioxetine may be considered a candidate for the treatment of patients with RLS. Although augmentation was not observed in the patients, its effect on augmentation cannot be clearly known since the follow-up is short.
In conclusion, we believe that studies should be conducted to investigate the efficacy of vortioxetine in the treatment of RLS. Therefore, randomized controlled studies are needed to determine the effect and safety of vortioxetine on RLS symptoms.
So it may be a useful antidressant in RLS and maybe could be trialled as a therapy for RLS. Sure only 7 patients but people here keep asking for something new, maybe here is something to try?
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