Just wanted to share a story. I've had RLS for about 15 years now and currently I take .5mg of Pramipexole twice a day, usually around 3, which works so-so, and then around 9. Gets me through the night OK...most of the time, not always. The reason I start so early is that if I lay down for a nap or to watch TV, my brain thinks I went to bed and then here comes the RLS.
About a week ago, for an unrelated ailment, I was proscribed Bupropion, which is an anti-depressent and aid for seizures.
What I found out and experienced is this: It does not exacerbate RLS and is a good alternative to many anti-depressants. I've been on it a week now. Now I'm generally in a good mood but this takes the edge of anxiety issues a little.
A couple days ago I took my first dose of Pramipexole at the usual time. Got busy with something and forgot about the 2nd dose. I remembered about 11 PM and thought: great, we'll be up a while tonight........nothing! Went to bed with out a single blip of RLS. The next night, same thing except I took the second dose at midnight. Same result....a good night's sleep.
Now, I don't know what's going on here, but it seems to be lengthening the time between doses or it's completely masking the symptoms.
I read a few articles about the relationship between Wellbutrin and RLS and there have now been a few studies on it which suggest that it can ease or relieve the symptoms.
I had no idea this was coming. This came right out of the blue with me, so I'd thought I'd share it. If I decide to be a test subject for myself, I'll just skip the second dose of Pramipexole and see what happens.
Just some food for thought. I'm not advocating for Wellbutrin by any means. Here are a couple links that give a little info on the subject:
Bupropion is the only antidepressant recommended in the Updated Mayo Algorithm on the Management of RLS, the RLS 'bible' published in 2021. Trazodone is also generally regarded as safe, and there have been some recent reports favouring vortioxetine.
While bupropion is widely used in the US, unfortunately it's not available everywhere: for example, here in the UK it's very difficult to get it prescribed as an antidepressant - in some areas one *might* be able to get it if you can convince a psychiatrist that nothing else works for you, but even then it's generally refused.
thanks for mentioning vortioxetine, I've done some research, it sounds promising. Every bit of new information counts for RLS sufferers, especially when the options of antidepressants are so limited.
Someone on here was very positive about their experience with vortioxetine (Brintellix), but for some reason I can't currently track down her post/reply or remember her name...
If it’s of any help , I’ve been on Bupropion, on prescription in the UK for a number of months with no issues at all getting prescriptions or supply. I had to get my psychiatrist to ‘nudge’ the GP for a repeat prescription and no issues since. Happy to share the paragraph quoted by the letter to my GP justifying it’s use if this helps.
That could be helpful. Looking back, I think you had it prescribed after a private appointment with a psychiatrist?
Guidelines in the one NHS Trust that I managed to find a few months ago were:
"Bupropion is licensed in the UK to aid smoking cessation... Bupropion is licensed in the USA for the treatment of major depressive disorder... (It) may only be initiated (here) by a Consultant Psychiatrist, who must have gained the approval from the relevant Head of Psychiatry... It may only be used for the treatment of refractory depression...This is an unlicensed indication in the UK... Consultants should liaise directly with the patient’s GP as this is an unlicensed indication and prescribing should remain in secondary care... Bupropion is approved for third-line use after two previous antidepressants have been tried".
A GP in that Trust advised that it was difficult to get into secondary care for depression.
On the other hand, if you are taking ".5mg of Pramipexole twice a day" - i.e. 1 mg/day, you are taking twice the recommended dose of pramipexole for RLS. Is that what you are taking?
You were asking for advice 6 months ago about coming off pramipexole and moving to gabapentin: did you not do that?
You've probably been told that dopamine agonists - pramipexole, ropinirole and rotigotine - are no longer recommended for treatment of RLS by experts. This is because they eventually lead to augmentation: you have to take more to less effect, RLS starts earlier, spreads to other parts of the body etc. And withdrawing from the drug becomes more and more difficult the longer you leave it.
Yes. I am taking that twice per day and have been for about 5 years. I do this because if I sit down for a long period of time, say to watch TV, the RLS starts up and once it starts, it doesn't matter how much you take. It has to run its course. So I pre-empt it in the afternoon and at night. It will be a godsend, though, if I can get off of it with Bupropion. I'll keep you posted.
So haven't you tried following SueJohnson 's previous advice on withdrawing and switching to gabapentin enacarbil as yet?
I know that's a tough process (thankfully I've never had to try it myself) but you'll need to do it eventually. Hopefully taking the bupropion will support you in this - so good luck and best wishes!
I did try. No luck. That's exactly what I'm thinking. On one of the abstracts it said that Bup is good for those that can't tolerate Dopamine antagonists, so sooner or later I need to do it. Probably sooner .
🤞 Keep up the Wellbutrin and hopefully half the Pramipexole and let us know how you do. Maybe in a few months you will be able to try reducing the 0.5mg
Bupropion is the only antidepressant that raises dopamine; the SSRIs raise serotonin, which is why they make RLS worse. It makes perfect sense to me that buproprion / welbutrin would help with RLS, and I don't know what it isn't prescribed for that.
I took it for a while many years ago but it caused me to have seizure-like movements of my jaw, and I stopped for that reason.
I've fought for this bupropian but in the UK they will not give it. So I'm depressed and can't take any antideppressant or mood stabilisers cos of the legs. It's disgusting.
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