I suffer from depression as a side effect from Buprenorphine and having tried pregabalin unsuccessfully (50mg/day) i asked my GP to prescribe trazodone. He was very reluctant and suggested sertraline.
Has anyone used this and does it cause RLS symptoms?
Thanks for any help on this
Davchar23
You do not want sertraline. It makes RLS worse!
Sue,
Thanks and i thought that was the case! I will avoid it.
My usually helpful GP was not keen on trazodone. He said it was an "old fashioned" drug which was mainly used by psychiatrists and he preferred other antidepressants,
Best regards
Davchar23
It may be old fashioned but who cares if it works. Aspirin is an old fashioned drug.
I advised you not to take it via message Davchar as it's a known to worsen RLS.Trazodone, Bupropion and possibly Vortioxetine are the alternatives.
Davchar,
I also experienced depression when I started Buprenorphine. Wellbutrin or Bupropion has helped me and without added RLS symptoms. Best of luck.
You can always try one of the safe anti depressants but I would caution you that because of your age especially, you could experience serotonin syndrome. This can happen when people use several serotonin and/or dopamine agonists together. Your doctor may not be aware as it’s quite poorly understood. I myself am extremely sensitive to this problem. Opioids are black listed for SS so if I have to be very careful with what else I take alongside it, even paracetamol gives me a slight touch of what I believe to be mild SS.
uptodate.com/contents/serot...
Dear Typicallygaslit,
Thank you for your warning which i will make known to my GP before i do anything. However i do not now take any DAs?
Do you think then that the side effects i get from buprenorphine (an opioid) could be in fact symptoms of SS? They are for instance sweating and nausea as well as depression?
Best regards
Davcha23
Davchar,
I don’t know about trazodone, but Wellbutrin (Bupropion) is not an SSRI and doesn't promote serotonin, so wouldn’t cause serotonin syndrome. It is a NDRI (norepinephrine-dopamine reuptake inhibitor) which is very different from a DA. I, personally, was unable to take it because it caused me extreme anxiety, but many people take it with great success. Best of luck.
Birdland
I have those same side effects and I know for a fact that my RLS goes deeper than it does for most, so I’m sensitive to a lot of the medications that other people deem safe. I’ve looked at the black lists for serotonin syndrome and I’ve been unable to tolerate any of the ones listed that I’ve tried throughout my life - the tolerance has gone down as I’ve gotten older. Symptoms I get are vomiting, diarrhoea, dizziness, tachycardia, agitation and increased RLS, nightmares, feeling hot. I can’t say for sure as I’m not medically trained, but I think it’s not impossible that the Buprenorphine is causing you and me a mild SS, also called serotonin toxicity (which I like better since the point is that many people may well suffer mild continuous toxicity rather than the dramatic extreme when you end up in hospital because of it).
All opioids are on the lists for SS. Buprenorphine is the one I tolerate the best, all the others seem to increase restlessness/agitation in me. But like you, I still struggle with side effects though obviously it’s helping with the RLS (which is really very strange but I guess somehow the beneficial actions override any action it may have on serotonin - a big mystery). All antidepressants have some action on the serotonin receptors, for instance (as far as I understand) Wellbutrin acts on both dopamine and serotonin. So I’d just be very careful. If you could try Trazodone, that would be good, but I personally did not tolerate it either. It made me really sick. I now can’t even take antifungals (which are also on the black lists).
I’m just a as lost as you in regards to the depression and the sweats, and so far my only way of managing the side effects is by taking the lowest possible dose, 340-350 mcg. But I also take a small dose of Tramadol (about 25 mg) just to get some sleep and this is increasing the side-effects since it also acts on serotonin. It’s far from ideal but I just could not find any other solution that I can at least live with until I come up with something better. The only upside is that these drugs counteract some social anxiety. I don’t believe I’ve ever suffered true clinical depression because I believe my serotonin levels have actually never been low, but rather the opposite. I suspect my lack of joy is more to do with low dopamine and low endorphin levels.
I hope this helps! I’m sorry it’s complicated. Good luck.
Thank you so much for such a detailed replied and whilst I have to admit that it was very complicated but did add to my knowledge on SS which i had not come across before. i will mention this to GP and use some of the information you have given me to back it. One point is that you mention the lowest possible dose of BUP as 340mcg. Do you mean per day ie 0.34mg and this is YOUR minimum? I use 15mcg patches ie 15x24=0.360mg/day
Kind regards
Davchar23
I’m glad you find it helpful, and yes it is complicated and very confusing, so don’t be surprised if your doctor shies away from it all! They aren’t always the brightest. I meant that MY lowest dose seems to be 340-350 mcg per 24 hrs, it’s a bit difficult to tell because it’s so hard to cut the pills. But bear in mind that I use some Tramadol a few hours later because it’s more conducive to sleep. I’m trying to work something out so I won’t have to. It’s just very difficult because with the pills, I’m trying to figure out the optimal time for taking the Bupe. My life is somewhat bearable like this but like you, I’d like a solution to the depression. In theory, fewer drugs is better but in practice I really struggle with insomnia.
I occasionally have to use a small portion of BUP tablet and I have a simple tablet cutter that enables me to gauge say a quarter of a 200mcg tablet (ie 50mcg).
I am lucky in that I do not suffer from opioid insomnia so no need for the Tramadol
Like you i tried and failed to find a suitable pattern to take my required daily dose of BUP using tablets. The half life and time for maximum effectiveness is difficult to gauge. Hence my reason to change to two patches (5mcg/hr & 10mcg/hr) which i stagger and leave on for 5/6 days. However I am working on a further reduction of the total use from 0.36mcg to say less than 0.30mg per day and thereby eliminating the remaining side effects (which as you say may be mild SS)
I appreciate your communications and hope you will report on any further thoughts you have.
Best regards
Davchar
Can I ask what kind of pill cutter you use as there seems to be many designs? I should get one!
I have only one idea really. I’ve tried all sorts of supplements but the only one that seems to help a little is l-theanine (extracted from green tea). The problem is that its efficiency tends to go down. The first time I took it, I felt extremely clear in the head and experienced great relief in my legs. I think it’s safe to take at night as it’s found in many herbal sleep products. Might make you feel a little less depressed. I also wonder if you’re more depressed because you have Bupe in your system all the time, have you noticed any difference?
this site apparently won’t let me post links so here is a screen shot
yes Sertraline can cause RLS. The dose for depression starts at 50mg daily, for anxiety starts at 100mg daily. I was on 200mg but now down to 100mg and hoping to get off it. If you do end up taking it take it first thing in the morning so you have lower levels at nighttime. Good luck.
I take Trazadone 10mg. I find Buprenorphine gives me total insomnia. Also, I feel quite "down" most of the time. The Trazadone does help a little I do usually get a couple of hours sleep but no more. Been on both of these for a couple of months now but now finding I'm having an hour or two of RLS in the evenings.
I like you found also that pregabalin was very unsuitable for me but I have not tried anything else for rls.
Hi. I am sorry to hear about your RLS and depression. It’s not easy. I would speak with a psychiatrist in terms of the right medicine. GPs are usually not as well educated in those meds as I learned the hard way. I have a terrible case of RLS and have read that some of the drugs they use for RLS diminish the effect of some SSRIs used to treat depression and anxiety but I haven’t heard of them making RLS worse. Although they all have their pros and cons, Paxil / Paroxetine has been the best for me but everyone is different. Best of luck!
They definitely do make RLS worse for most.
Antipsychotic drugs, especially drugs made from haloperidol or phenothiazine. Doctors prescribe these drugs to treat schizophrenia and other mental illnesses.1
Antidepressants treat depression and other illnesses. If you have RLS, avoid antidepressants that boost serotonin and/or those known to worsen RLS symptoms, including:1-3
Fluoxetine
Sertraline
Mirtazapene
An exception to these is buproprion, which should be considered for treating depression in RLS patients, according to the most recent guidelines.2
Cold and allergy drugs, particularly ones like diphenhydramine that have older antihistamines. Both prescription and over-the-counter drugs that treat colds and allergies can have this ingredient. Benadryl® is one.1-3
Agreed
davchar23 Antipsychotic drugs, especially drugs made from haloperidol or phenothiazine. Doctors prescribe these drugs to treat schizophrenia and other mental illnesses.1
Antidepressants treat depression and other illnesses. If you have RLS, avoid antidepressants that boost serotonin and/or those known to worsen RLS symptoms, including:1-3
Fluoxetine
Sertraline
Mirtazapene
An exception to these is buproprion, which should be considered for treating depression in RLS patients, according to the most recent guidelines.2
Cold and allergy drugs, particularly ones like diphenhydramine that have older antihistamines. Both prescription and over-the-counter drugs that treat colds and allergies can have this ingredient. Benadryl® is one.1-3
Pregabalin side effects 
Pregabalin side effects
Ropinerole Side Effects
BUPRENORPHINE
Gabapentin Side Effects
