My recent posts are about insomnia with Gabapentin. I have found suggestions that Wellbutrin XL is possibly the culprit. My husband's psychiatrist has suggested Mirtazapine which is an antidepressant that helps with insomnia. Has anyone had any experience with this medication? My concern is that I have been having insomnia even though I am on 1900 mg of Gabapentin for severe RLS. I am having great success with the Gabapentin in controlling my RLS after experiencing augmentation due to years of Pramipexole. Once I realized that Floxetine may be a contributing factor to the RLS, I was switched to Wellbutrin XL on the suggestion of my Sleep Medicine Specialist. Once the insomnia began, we tried increasing the Gabapentin but had no success. I am researching Mirtazapine in hopes of resuming normalcy in my sleep habits,
Like so many medications for depression, there is the chance of worsening syptoms. Isn't it ironic how the medications that we have available seem to fix one problem as well as cause another?
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Mirtazapine worsens RLS. The only safe anti depressants are wellbutrin and trazodone.The only other option I can think of for your insomnia is medical cannabis.
Or possibly switch to pregabalin. The insomnia side effect on gabapentin may not happen on pregabalin. They are in the same class of drugs but are metabolised differently. Some find side effects on gabapentin don't happen with pregabalin, and vice versa.
Thank you for your reply. As akwaysm this is very helpful and much appreciated. What never ceases to amaze me is that a psychiatrist who is an M.D. suggested this. When will the overall medical community ever "get it" about RLS? Again, thank you.
It is tragic. RLS isn't taught at ANY stage in medical training.The basics are:
1. Raise serum ferritin above 100, preferably 200 by pills, but faster by iron infusions
2. Review ALL meds & switch patients OFF meds that worsen/trigger RLS (all anti depressants, sedating anti histamines, statins, beta blockers, PPI meds)- although some statins/beta blockers are tolerated.
3. If 1 & 2 don't improve RLS, start patient on gabapentinoids.
4. If 3 doesn't work, start patient on low dose, long half life opioids like Buprenorphine or methadone.
5. AVOID, AVOID AVOID dopamine agonists.
Ta Da!
If GPs were taught JUST the above, it would make an enormous difference.
Yes, I realise I'm one of the lucky ones and grateful too. I started taking antihistamine at night to help me sleep not knowing that it can aggravate rls. Only realised it can by reading it in a post a while later.
Thank you for your reply. As akwaysm this is very helpful and much appreciated. What never ceases to amaze me is that a psychiatrist who is an M.D. suggested this. When will the overall medical community ever "get it" about RLS? Again, thank you.
I was taking citalopram which can not be taken.pramiolexol ,when I.asked this question I was told it was fine ,it wasn't, I had to ween myself off both .....the information out there from medics is shocking
I’m bombarding you, sorry. But your experience will help others. I’m gonna assume here that the Citalopram came first and it turned your paracetamol controlled RLS into the devil incarnate? No one made the connection and you were prescribed Prami? Then you weened off both, but maybe with the Prami being started and stopped a little thereafter until it was totally ineffective and it was making your RLS worse, not better.
Ok, it sounds like you did down-regulate your receptors mildly. Time is your friend. Your receptors will crawl back to baseline over 3 to 6 months. In the meantime your symptoms are completely under control. You choose when you want to try reducing the Gabapentin. Don’t get complacent! You’re young. No reason to be on a drug you didn’t need pre-DA.
I was put on Mirtazapine for Anxiety Induced Depression two weeks ago.
I told the doctor about my restless legs & he said no problem. What?
I entered a four day nightmare of dreadful side effects, including a dramatic worsening of restless and in addition permanently restless arms, on top of which I had violently psychedelic dreams and a hammer banging in my head.
I was so angry that the careless doctor had prescribed them when the side effects described inside the box included a worsening of restless legs if you already suffer and if you don't already suffer, you will do on these tablets.
I am now back on Sertraline.
When I was in a caring gp practice,I was prescribed Clonazepam for my RLS. I also need iron infusions occasionally if the Haematologist will agree, which he often won't, as my body can't store Ferritin and I can drop to as low as 7. If it only goes down to 50 that is considered normal,
But back to Mirtazapine, I wouldn't touch it, although if it wasn't for the violent RLS and arms I have a feeling it would have helped my anxiety condition ultimately.
Thank you for sharing and I am sorry that you had to go through that. It is sad how ill prepared general practicioners arrre in regard to RLS. They are charged to "Do No Harm" yet either they or the pharmacuetical companies need to make efforts educate the profession on these RLS traps.
I read on here that lamotrigine, which I was taking for depression, could be a contributor of RLS. My Dr. weened me off of it and put me on Trazodone, which is also an antidepressant, but also aids in sleep. I take it with my last Gabapentin about a half hour before bed.
Hello - sorry to hear about your situation. I have RLS (I take Ropinirole) and have recently started take Mirtazapine for depression. As of yet (only 2 weeks in) I have not noticed any difference with my RLS - in fact because it makes you drowsy I have noticed the RLS less because I am falling asleep more easily. Obviously this may change over time but so far so good.
I took mirtazarpine for 20 years in combination with other antidepressants my psychiatrist gave just 7.5 mg the lower doses and it was working. I got better and I was out of the other medication I stayed with mirtazarpine and gabapentin but very low dosage at that moment I didn’t have RLS and when a new dr increase the mirtazarpine that’s when the RLS started and I wanted to stopped because I wasn’t feeling depressed anymore the dr didn’t want to take a chance and after having COVID and now long COVID symptoms the new dr immediately took out of mirtazarpine because it was increasing dryness inside and out. It was vey hard I was to do it in 4 months and I am glad I don’t need it anymore but the RLS didn’t stop I am taking gabapentin that I know is not working for me but the withdrawal symptoms are harder and difficult than any antidepressant so I am stuck with it for now. All other medication the side effects are greater than helping so now I am taking some herbs someone recommended here besides some creams to rub in my legs I learned few acupressure points for the condition and doing that has been helping me deal better. That was my experience with mirtazarpine just to let you know lower doses ok bigger doses RLS
You can decrease your gabapentin. If you are having withdrawal symptoms, you need to go slower by 100 mg and wait for maybe 3 weeks before the next reduction. If even that is too much, open the capsules and buy a jewelry scale and measure half of it. You are obviously having a harder time of it than most but if you do it slowly enough you will have NO withdrawal symptoms.
I don't believe your response applies to my situation because you may not have read my whole history which is a little complicated. I am glad that you found your solution.
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Insomnia with mild RLS
DESPERATE 
Longest bout of RLS 13 days of no sleep
RLS specialist in Ireland
