update, and buprenorphin and anxiety/depression

[Kejimkujik]

well my amazing support network, with your advice and support I have now been off pramipexole as of June 1st. I was up to 900mg gabapentin and on the advice of my lovely neurologist, I started using Saloxone as a rescue when rls attacks occurred. By mid June as I increased the gabapentin I found I was not able to tolerate it. It made me function like I did three months into a traumatic brain injury two years ago. I called the neurologist and she suggested coming down 100mf at a time from the gabapentin and to use the saloxone instead and that this possibility is precisely why she had prescribed it for, in the event the gabapentin does not work. So I started with 1/4 tablet of a 2mg buprenorphine/ 1/2mg naloxone. It worked quickly and completely within 20 mins and lasted about 6hrs. I then found the rls was kicking in and I was dealing with the gabapentin side effects. That was a rough few days. I have now mostly settled at taking zero gabapentin, and 1/2 saloxone as tqo 1/4 tablets taken four to six hours apart. This wrked well for the most part with occasional breakthroughs of rls for which I tokk another /4 tabler. I did try cutting the 1/4 smaller but they just crumbled away. For about ten days I was taking effectively 3/4 tablet a twenty four hour period as 1/4 portions. The last week I or ao I have been waking up and experiencing terri le anxiety and depression that would last jntil the mid afternoon. It was seriously affecting my mental capacity to function and this added to my anxiety. I have rediced the dose to 1/2 a tablet most days with the very occassional extra 1/4 on an as needed basis only. Am I correct that buprenorphine can cause anxiety and depression or could it be something else going on? Otherwise I have to be honest I have had a reasonably manageable withdrawal from pramipexole. When it gets bad or through the anxiety attacks and depression , you have all been the inspiration I have needed to not feel utterly isolated And alone and to stick with it. Any advice re- buprenorphine is very welcome. Would it help to take say up to 300 mg gabapentin?

[SueJohnson]

Congratulations on coming off pramipexole. Those are common side effects. They may get better as your body adjusts to them or they might not, For anxiety Joolsg suggests 25 mg of pregabalin. If that doesn't work buspar is safe for RLS. but takes 2 to 4 weeks to work. For depression Wellbutrin or trazodone. Trazodone can also help with anxiety.

[Joolsg]

You are experiencing a triple whammy.Reducing gabapentin causes anxiety/ depression..Getting off Pramipexole causes anxiety/ depression (DAWS) that can last months. You 've only been off it a month.

And yes, Buprenorphine can cause opioid induced anxiety.

So, stay on the 1mg Buprenorphine, but perhaps stay on 100mg gabapentin or ask for 25mg pregabalin. Dr Buchfuhrer advised me to add 100mg gabapentin or 25mg pregabalin to my low dose opioid to counter the opioid induced anxiety.

As your body adjusts to the Buprenorphine and getting off Pramipexole, the anxiety should settle.

[Simkin]

After 6 months of taking buprenorphine I had suddenly 6 weeks of awful depression, not wanting to go out & face the world & tears galore.I did wonder if it was the pills but I honestly now think it was caused by what was going on in my life.

I persisted with the pills & luckily the cloud has lifted.

[RiversW]

Dear Kejimkujik,

My experience has been similar to yours. With the help of Buprenorphine, I withdrew completely from Neupro 5 months ago. For the first time in 30 years I was sleeping through the night without an unwelcome visit by RLS. However, I started suffering bouts of mild to moderate anxiety and depression. Fortunately, Wellbutrin reduced this problem significantly. I was doing pretty well until I decided to eliminate Pregabalin from my meds diet. I had started Pregabalin about one year ago. My neurologist was attempting to address my increased symptoms caused by augmentation; with little or no effect I thought. After Buprenorphine was introduced and working well, I believed Pregabalin could be taken out of rotation. I proceeded to reduce the dose way too fast from 200 mg to 75 over two weeks. My depression and anxiety went through the roof or more accurately the roof came crashing down on me. Long bouts of crying. Men don't cry! Well, that has never really been true for me, but now my crying jags were much more frequent and intense...and scary. When I tried to venture out of the apartment anxiety would overwhelm me and I would retreat depressed, often to the bed for hours at a time. I was paralyzed with fear. As I have done for the last 6 months, I asked this community for help and as has been the case for the last 6 months, they so generously gave it. The consensus was that the severity of the anxiety and depression was probably the result of decreasing the dose of Pregabalin too quickly. I followed their advice and restored my dose to 200 mg and PRESTO! the roof lifted. Though the depression and anxiety have not been eliminated entirely, they visit much less frequently and are not so scary. Like Simkin, I believe outside influences probably triggered these episodes of depression/anxiety. However, I also believe that withdrawing from the Pregabalin too quickly sent the depression and anxiety into overdrive and to a point where it was unmanageable. It's so tricky this dance with the medications and as has been accurately said here many times, everyone responds to the meds differently. Trail and error, a lot of error on my part, seems to be the only way to find the right balance. I don't think I have really found that balance yet but I am getting closer and you will too. Best of luck to you. Rivers