Hello, I have had RLS since my early 20's, (I'm 66). I am currently taking .5 Pramipexole and would like to begin weening off with the goal to stop taking it entirely.
Has anyone been able to successfully return to Celexa after a break in taking it? I tried Wellbutrin and it did nothing for anxiety. Any other suggestions for anxiety meds that don't aggravate RLS?
Thank you, Pat
If Celexa made your RLS worse before as it does for many, it will do so again.
First off check if you are on the slow release pramipexole. The slow release ones usually have ER or XL after their name. If so you need to switch to the regular pramipexole because the slow releases ones can't be cut.
To come off pramipexole reduce by half of a .088 [.125] tablet) every 2 weeks or so. You will have increased symptoms. 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 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. But in the long run, you will be glad you came off it.
Dopamine agonists like ropinirole and pramipexole are no longer the first line treatment for RLS. Gabapentin or pregabalin is. (Pregabalin is more expensive than gabapentin in the US.) The beginning dose is usually 300 mg gabapentin (75 mg pregabalin) [If you are over 65 and susceptible to falls beginning dose is 100 mg (50 mg pregabalin.)] Start it 3 weeks before you are off pramipexole although it won't be fully effective until you are off it for several weeks. After that increase it by 100 mg (25 mg pregabalin) 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. (You don't need to split the doses with pregabalin) 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 (it is OK with pregabalin) 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 (not sure about pregabalin). 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? This is the first thing that should be done for RLS. Improving your ferritin to 100 or more helps 60% of people with RLS and in some cases completely eliminates their symptoms. 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.
Sue has given advice generally and on coming off pramipexole.
Citalopram (Celexa) makes RLS worse for many.
Trazodone is used to treat major depressive disorder but can also "decrease anxiety and insomnia related to depression". It is generally said to be safe for RLS, although some people still report that it makes RLS worse.
Buspirone (Buspar) is primarily used to treat anxiety disorders and is also generally said to be safe for RLS.
Since you live in the US Wellbutrin and trazodone are both good for depression. Wellbutrin is probably the better of the two.
You might want to try some non-pharma solutions. N-Acetyl-Cysteine (NAC) is not quick acting at all (may take many weeks) but it is an innocuous amino acid supplement that can eliminate anxiety and assuage sleep disturbances.
Do you take NAC DicCarlson ? If so, do you find it effective?
I used Celexa for many years before my RLS became problematic. I tried Wellbutrin later and it heightened my anxiety, obviously the wrong direction! I'm stuck with periodic high anxiety & depression while enjoying success with gabapentin for RLS. I noticed a few posts about St. John's Wort (SJW) that seemed worth looking into. I haven't taken the plunge yet. My latest scourge is migraine, which is sometimes treated with SJW.
Have you tried trazodone? It helps both depression and anxiety.
It's contraindicated for glaucoma. Plus it is sedating & I already have this minor side effect from gabapentin.
I'm out of suggestions then because the other three I would have suggested aren't safe if you have glaucoma.
The only thing you could try is to take the Wellbutrin and try waiting for tolerance to develop and if that doesn't work use a benzodiazepine or propranolol to control the jitteriness. psychiatrictimes.com/view/m...
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UPDATE: RLS, magnesium, calcium and hard water
