Hi , after trying very hard to navigate depression without drugs I have now just started Trazodone .
Taking Gabapentin successfully, only mild RL .
Had every dopamine drug for many years and now completely free of them for at least 6 months .
My question is although Trazodone is deemed not to affect RL I have unfortunately found that in my case they have made my symptoms worse? I have the restlessness in my arms too .
I’m hoping this is just in the initial phase of beginning treatment ?
Is there any other antidepressants ?
I have tried lots of others in the past and they all exasperated RL enormously!
Help !!!
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Rubynessie
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While trazodone is generally regarded as being safe for RLS, a few others have also reported that they have found that it appears to exacerbate their symptoms. It is possible that you will find this wears off: the NHS does say that some of the side effects of trazodone "will gradually get better as your body gets used to it".
The other antidepressant regarded as safe for RLS is bupropion, but in the UK this is generally now only prescribed to help stop smoking under the brand name Zyban (in the US for example its used as an antidepressant as Wellbutrin). A while back I remember that I found a reference to an NHS Trust who were still prepared to prescribe it here as an antidepressant in some circumstances - I'll see if I can find the reference..
Meanwhile I hope that your body will adjust to the trazodone.
Any idea why Wellbutrin (Bupropion) is usually only given for smoking cessation? I was put on the med for anxiety. I know it's used mainly for depression here in the U.S. but it's also commonly prescribed for anxiety. The beginning dose is 75mg but most people need to go up from there. I am on a once a day dose of 150mg. It does not affect my RLS. Thank God. I hope the trazadone works well for you and the symptoms of RL diminish. If not, I really hope you can get, easily, the bupropion. Best to you!
I believe that it was withdrawn from the market internationally because of reports of seizures in the mid 1980s but re-released in 1989 with a lower maximum dosage. I have read that GlaxoSmithKline withdrew the UK licensing application after bupropion was linked to an increase in psychiatric abnormalities (suicidal ideation, personality changes, mania, and psychosis).
In the UK it is now only licensed for the treatment of nicotine addiction, though it can be prescribed off-licence for ADHD and for depression in some NHS Trust areas. It is however very difficult to get it prescribed for depression - typically only after two previous antidepressants have been tried and after an interview with a psychiatrist. Even then, RLS sufferers who have been through that process have had it refused.
I'm so surprised you can't get bupropion in the UK for depression. In the cold, harsh agony of Pramipexole withdrawal, my doc prescribed it in the US for my depression/anxiety. I've never heard of the problems identified in the UK. I started it about 10 days ago; so far, no RLS, no side effects, slight improvement in mood.
300 mg total, starting at 100 then adding 100 mg per week for 3 weeks until reaching 300. I'm currently at 200 mg. I have taken this in the past and also was at 300 mg without any side effects. It's actually quite common here, so it's surprising to me it's only for smoking cessation in UK.
So, I hope that you find that the trazodone settles down. However the UK exception on bupropion that I came across was Kent & Medway NHS Trust which says:
"Bupropion may only be initiated by a Consultant Psychiatrist, who must have gained the approval from the relevant Head of Psychiatry, using the named-patient form in this guideline.
• It may only be used for the treatment of refractory depression
• This is an unlicensed indication in the UK and patients must be given the unlicensed medicines information sheet and consent form found in the KMPT medicines management policy. There is an information leaflet available on the choice and medication website.
The usual starting dose of bupropion is 150mg XL once daily. The usual target dose is 300mg XL once daily but can be given in divided doses.
• Consultants should liaise directly with the patient’s GP as this is an unlicensed indication and prescribing should remain in secondary care.
1. Prescribing
1.1 Bupropion is approved for third-line use after two previous antidepressants have been tried.
1.2 Bupropion may be used as an adjunct to an SSRI or as single treatment.
1.3 There is no specific guidance when switching to bupropion but the Maudsley recommends to cross-taper cautiously for most antidepressants. MAOIs must be stopped 2 weeks before bupropion is started.
1.4 It is recommended that patients are initiated on 150mg XL daily and that the dose is not increased for a minimum of 4 days
1.5 The maximum dose recommended by the Maudsley is 400mg daily; however bupropion is
only available in the UK as 150mg XL. The maximum dose recommended by KMPT is therefore 300mg daily (the maximum licenced dose in the USA).
1.6 This is an unlicensed indication in the UK and patients must be given the unlicensed medicines information sheet and consent form found in the KMPT medicines management policy"
You may find that your own NHS Trust has a similar exceptional policy.
This may be irrelevant, but a few years ago I was prescribed Wellbutrin and about a week in developed hives all over my body, which put me in hospital. Hoping no one else has that reaction. It was most unpleasant! If you do start to develop an itching sensation which precedes hives take Benadryl and get to the ER asap. I went to my GP, who sent me to a dermatologist, who sent me to an allergist. Skip those steps; by that time I was unrecognizable.
Thanks for raising this. Skin rash, hives, or itching is a 'less common' serious side effect of bupropion which should be checked with a doctor immediately and may need medical attention. As you discovered: hope you recovered quickly
Desipramine Nightwalkers a publication of the Restless Legs Foundation in the US says it is safe for RLS as does Dr Buchfuher and it is available in the UK.
Desipramine is a metabolite of imipramine, and while imipramine is listed in the BNF the only references I can currently find to desipramine in the UK are old/broken links. Any further info?
Great, thanks Sue! I'll follow up with UK Rehab and try to find out why BNF/NICE only include imipramine in their TCA list alongside amitriptyline, clomipramine, dosulepin, doxepin, lofepramine, nortriptyline and trimipramine.
UK Rehab haven't responded to my query about desipramine (Norpramin), but I noted that their piece says "research is ongoing into desipramine’s ability to reduce cravings".
I checked with a knowledgeable doctor involved in RLS research who said "I had to look up desipramine because I have never seen it prescribed in the nearly 40 years I've been in the NHS. The only reference I could find from the UK was the same one about addiction. I did find an advert....for an injectable form 'for research only'. As a result I do not think it has a licence in the UK."
I looked up the ad referred to and it says "This product is for research use only and is not for human consumption or therapeutic use."
As desipramine is a metabolite of imipramine, one has to wonder whether Nightwalkers/Dr Buchfuher would recommend imipramine. That is prescribable here for depressive illness but there are cautions around its use and I don't believe that it is widely used.
Good luck with your efforts to get buproprion. I was OK with trazodone, in fact when I first started taking it I felt it eased RLS slightly. However I had other side effects and tried to get bupropion prescribed. Was referred to psychiatrist and although I was profoundly depressed she would not prescribe it The psychiatrist was more interested in my dihydrocodeine prescription and so I got out of the consulting room as fast as possible.
A great shame that you couldn't continue with trazodone and weren't allowed bupropion: it would be interesting to find out how widely bupropion might be available in the UK if one was able to jump through enough hoops. (You'll have seen the Kent info that I listed above - presumably you're in another NHS area?)
I live in Gloucestershire and have suffered from severe depression for over 40 years. I was told by an excellent psychiatrist that the best I could hope from antidepressants was that they would take the edge off of my depression. Friends said that was a rather cruel remark but I liked his honesty.
hi, I have recently been prescribed Trazadone , I had to fight to get this drug , so I was very disappointed when it made the RLS worse , I also tried to get Bupropion, which is recommended for RLS, but my GP wouldn’t prescribe it , so I was referred to a consultant, who also will not prescribe it , it is no longer licensed in the UK for anxiety and depression, and is classed as a very old drug . However I was prescribed beta blockers, they help with the physical side of anxiety , and these do seem to take the edge off my RLS, which is very severe. Hope this helps , as having depression and anxiety along with RLS is horrendous .
While bupropion can theoretically be prescribed off-licence for depression in the UK in at least some Trusts, under the guidance of a psychiatrist/specialist, you and Ellsbells have both found that this is very difficult. Glad that you've found that beta-blockers help, and that they don't make RLS worse in your case.
Thank you , unfortunately beta blockers only help with the physical symptoms of anxiety , so not actually treating the anxiety/depression directly, I’m currently off work , due to depression/anxiety , and fighting with Drs is very difficult when your already feeling at the lowest , however they did discover that my thyroid function is rock bottom even tho I take 100mg ever day , with the increased dose of thyroxine I’m hoping my mood will lift , and my RLS ease as they are also horrendous at the moment , I’m currently taking 30mg of codeine every 2 hours and 500 paracetamol every 4 hrs to get me through early evening and night . I have also now started taking selenium ( amongst other supplements) with the hope this will help the thyroid as well as the RLS . I wonder what other people’s experience is with selenium ?
There have been a few Posts and Replies about selenium including the following, which suggests that selenium can be helpful but that it can take quite a while to be effective:
I was given Trazadone a couple years ago for a one night hospital stay. The biggest takeaways that I had were the hallucinations....big time. Ordinary people walking out of walls, walls turning to all leaves. Weird part was nothing scared me or was threatening. I just watched the show in awe and eventually slept. Wouldn't do it again, though.
I've been using Trazodone as a sleeping aid for almost two years and I've had no adverse effect with RLS. I take at at 9:30 pm. I'm still taking Methadone (7 mg) and Pregabalin (200 mg).
At what time are you taking your Trazodone? If it's used as anti-depressant, are you taking it in the morning?
Hiya - I take Trazodone, for two reasons: sedative add-on to other antidepressants and to knock me out at night because at some point during nights, the rhopinirol and gabapentine wear off! TBH for this reason I couldn’t do without it - but I hadn’t thought about augmentation with it. Sorry not being v helpful - except that in general ADs do cause augmentation from what I’ve gathered here. Hope you’re ok
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