RLS and antidepressants

[Sylviet]

I am one of those people who have to take antidepressants which I know is a contributer to RLS. Does anyone on this forum take antidepressants and what can one do about this and RLS. About a month ago I dumped Pramipexole and am going through withdrawal. Ugly! But I want to persevere. I do take gabapentin 300 x 2 at night. I have been spacing them out thinking this may give me more sleep but given I am in withdrawal I can’t tell if this is the right thing to do. Any ideas?

[SueJohnson]

Wellbutrin and trazodone are the only 2 antidepressants that are safe for RLS.

[ChrisColumbus in reply to SueJohnson]

There was a 2018 review that suggested: "Sedating antidepressants such as trazodone, nefazodone, and doxepin do not seem to aggravate periodic limb movements. The current evidence is limited by poor study design, inadequate use of standardized questionnaires..."

I know that we currently only see bupropion and trazodone as 'safe': were nefazodone and doxepin subsequently definitely ruled out re: RLS?

pubmed.ncbi.nlm.nih.gov/288...

[SueJohnson in reply to ChrisColumbus]

Nefazodone is not available in the UK and has a risk of liver disease which is why I don't mention it. Doxepin is a tricyclic anti depressant and is known to make RLS worse.

[ChrisColumbus in reply to SueJohnson]

Thanks - I should really have researched myself, but have been distracted by England losing to Spain in the Euro footie!

[SueJohnson]

If you stopped pramipexole cold turkey that was a bad idea. You need to wean off it slowly. If you did I would suggest you go back on it and come off more slowly by reducing by half of a .125 mg tablet every 2 weeks. You may need to reduce more slowly or with a smaller amount or you may be able to reduce more quickly. Wait until the increased symptoms from each reduction has settled before going to the next one. You will suffer although a lot less than you are now if you came off cold turkey and may need a low dose opioid temporarily to help out with the symptoms especially as you near the end. Some have used kratom or cannabis temporarily to help.

Since you are suffering withdrawal symptoms the gabapentin won't help much. Once the symptoms have settled increase it by 100 mg every couple of days until you find the dose that works for you.

Take it 1-2 hours before bedtime as the peak plasma level is 2 hours. 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.

Most of the side effects 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. If you take magnesium even in a multivitamin, take it at least 3 hours before or after taking gabapentin as it will interfere with the absorption of gabapentin and if you take calcium don't take it within 2 hours for the same reason . According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin (200 to 300 mg pregabalin)."

Have you had your ferritin checked? If so what was it? That is the first thing a doctor should have done. You want your ferritin to be over 100 as improving it to that helps 60% of people with RLS and in some cases completely eliminates their RLS and you want your transferrin saturation to be between 20 and 45.

If not ask your doctor for a full iron panel. Stop taking any iron supplements including in a multivitamin 48 hours before the test, don't eat a heavy meat meal the night before and fast after midnight. Have your test in the morning before 9 am if possible. 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. If you can't get an infusion, let us know and we can advise you further.

Check out the Mayo Clinic Updated Algorithm on RLS which will tell you everything you want to know including about its treatment and refer your doctor to it if needed as many doctors do not know much about RLS or are not up-to-date on it as yours obviously isn't or s/he would never have prescribed a dopamine agonist at Https://mayoclinicproceedings.org/a...

Some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, artificial sweeteners, carbs, foods high in sodium(salt), foods that cause inflammation, ice cream, eating late at night, oestrogen (estrogen) including HRT, 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, fennel, 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, CBD, applying a topical magnesium lotion or spray, doing a magnesium salts soak, vitamins B1, B3, B6, B12, C, D3, K2, if deficient, and potassium and copper if deficient, massage including using a massage gun, vibration devices like therapulse, using a standing desk, listening to music, meditation and yoga. Keep a food diary to see if any food make your RLS worse.

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.

[Sylviet in reply to SueJohnson]

Thanks for your reply. I did not stop Pramipexole cold turkey but lowered the dose over a couple of weeks. Perhaps that wasn’t the right way to do it but now I am a month into it and hate to go back and start over. I have tried Wellbutrin in the past and thought Trazedone was a sleep medication (which does not work well). My doctor just prescribed a month supply of Klonopin which works but I don’t want to rely on it. I am on Pristique as an antidepressant so it sounds like that’s a big culprit. I am in the throes of a depression so I don’t know what to do.

[SueJohnson in reply to Sylviet]

I can understand your not wanting to start over. Can you get a low dose opioid. Tell your doctor it is just temporary to help you with your withdrawal. Show him/her the Mayo Algorithm portion that discusses low dose opioids. I would recommend buprenorphine or methadone as they are long lasting. Most of the others last only 4 to 6 hours and need to be taken that often or you will have mini withdrawals. If you are prescribed one of the others be sure you are given enough to take them that often

Yes pristique is a SNRI antidepressant that makes RLS worse. Trazodone does help with insomnia but is mainly an antidepressant.

The problem with Klonopin is it has a long half life of 40 hours so can cause sleepiness the next day. I would recommend lunesta.

[Chouette24]

Wellbutrin does not cause RLS. It’s the only (as far as I know) that does not contribute to RLS. It worked for me until I got off of it.

[ChrisColumbus in reply to Chouette24]

Unfortunately bupropion (Wellbutrin) is not available in all countries: in the UK it's not prescribable as an antidepressant except in some areas where it might be prescribed after an interview with a psychiatrist.

While trazodone gets occasional reports of triggering RLS, it is generally considered safe - and can also help with anxiety and insomnia. (It's often difficult for RLS patients to identify what is really triggering their RLS).

There have also been some recent reports that vortioxetine (Brintellix, Trintellix) has proved safe for RLS for some sufferers. However, "we're all different" - as we used to say quite often on here - and it may be these reports come from people who just happen to be tolerant of this antidepressant.

[maribarosay]

I use cymbalata.

[ChrisColumbus in reply to maribarosay]

It's great if it helps you: some others report that duloxetine (Cymbalta, Yentreve) makes RLS worse. We're all different!!

[SueJohnson in reply to maribarosay]

It certainly made my RLS worse. My RLS is completely controlled by gabapentin and I can take many things that trigger RLS in others like melatonin and benadryl but cymbalta sent me through the roof. Glad it is OK for you.

[Eryl]

You can probably get off antidepressants and relieve your RLS by changing your diet. youtu.be/9SKYlvfRofs?si=QZc...(Not working as expected?)

[Bernaldi]

If you are taking an SSRI (raises serotonin) then your dopamine is going to appear to go down in response. That is why SSRIs cause RLS to get worse. Your doctor should have known this if I do.