I am really struggling at the moment with anxiety, depression and am ever on the edge of a panic attack. I started to taper Ropinirole on October 14th so it's been five weeks and the really hard symptoms have started in the past week or two and they are escalating. I was taking 1mg and sometimes 1.25mg of Ropinirole and the RLS symptoms were getting worse so i knew i had to do something about it. I went to see Dr Fackrell and he prescribed Buprenorphine. I am not getting any support from my GP in the transition. I am currently taking 0.25mg Ropinirole a day in two doses and am going to cut them down until I am taking them no longer. I am taking 4mg a day Bup in four doses and am wondering if upping the dosage would help alleviate the anxiety and depression. Dr Fackrell did say to take more as I came off the Ropinirol - he said not to exceed 1200mg a day in four doses. He also said that, once off the ropinirole completely I should reduce the amount of Buprenorphine until I reach the level that works for me. What I am really asking for advice on is whether taking more Bup with ease the symptoms of tapering the Ropinirole. Once more thank you for your help and advice with this.
Struggling with depression and panic ... - Restless Legs Syn...
Struggling with depression and panic attacks as tapering off ropinirole.
Just to add that I am supposed to be getting my covid jab tomorrow - is it best to put it off for a while as it might make me feel even worse than than I do now? Any experience of this?
Difficult. Obviously withdrawal from Ropinirole causes depression & anxiety because your brain has been flooded with a drug to increase dopamine uptake in the brain. That is being taken away & your dopamine receptors first have to settle and then your brain has to relearn how to make dopamine and uptake it via the receptors.But- Buprenorphine ALSO causes anxiety and depression for some people, especially if being taken throughout the day rather than just at night.
I developed panic attacks on 0.4mg Buprenorphine and added 50mg pregabalin to counter the attacks on the advice of Dr Buchfuhrer. It worked for me. I then reduced it after about 2 weeks and the panic had gone.
As you are so close to getting off Ropinirole, I would continue the process.
Dr Earley is of the view that it is a hellish process whether you reduce slowly over 6 months or quickly over 3 weeks. But at least with the quick method, you are off Ropinirole faster and your brain and dopamine receptors can start to heal.
If you're otherwise fit and healthy, and feel strong enough, you could be off Ropinirole in less than 3 or 4 weeks.
The serious withdrawal will then take place over the following 2 weeks.
It really is down to you.
If you can't manage, slow down.
But I wouldn't increase the Buprenorphine yet. You need that more for when you drop the last dose.
For the panic attacks, insist your GP helps you. The GP caused the problem by prescribing the Ropinirole, so they should help you through the withdrawal. Ask for between 50 and 100mg of pregabalin and also 10mg diazepam maybe 2 or 3 times a week to reduce the panic.
Thank you for this, Jools - much appreciated. I had a call after writing that post from one of the doctors at my surgery after I had spoken to 111 this morning - they requested that they got in contact with me. The doctor hadn't realised that withdrawal from Ropinirole could cause these symptoms and he looked it up whilst we were on the phone. He was thankful to me for highlighting that for him. He was suggesting anti depressants which I did not want to take but, having looked at the side effects of withdrawing from Ropinirole his suggestion is that I may have done it too quickly and that I increase the amount I am taking and then reduce it more slowly, every two weeks, before finally stopping. He's given me a detailed plan of how I should reduce it. He also said to take 2mg Buprenorphine before bed and if I need more to take 2mg during the night if the RLS starts to play up. I actually have pregabalin as I did try it to see if it would work for me with RLS but it didn't. Might taking a small dose help? It made me feel really woolly so perhaps best avoided. I have Lorazapam that I take for anxiety on rare occasions to do with my AFib. Am I right in thinking they would have the same effect as diazepam in this instance? I have taken half a 1mg pill but it didn't seem to do much. Again, thank you for your time.
Lorazepam will help in the same way as diazepam. It's in the same class of drugs.And the Buprenorphine - I presume you mean 200mcg /0.2mg? 2mg is a very high dose.
Sadly, you can't really avoid increased, severe RLS, even by adding Buprenorphine. You can just reduce the worst of the withdrawals.
I would stick with 0.4mg Buprenorphine for now as Buprenorphine definitely adds to panic in the first few weeks.
Pregabalin doesn't help RLS until around 4 weeks after the last dose of Ropinirole. But it might reduce the panic attacks.
Yes, of course, 200mcg/0.2mg. What are your thoughts on the Drs recommendation to increase the ropinirole and then taper it more slowly given how much I am struggling with the mental health side of things?
I would personally NOT increase it, but stay on your current dose for longer until the lorazepam/pregabalin stop the panic attacks. And only then try to reduce by a further 0.25mg.It is a horrible, horrible process. If more GPs realised how traumatic and brutal dopamine agonist withdrawal really is, they would stop prescribing it.
I doubt that a GP whose ignorance caused augmentation can understand the difficulty of weaning or have any useful advice.
Hi Jools, I've been given 2mg diazepam by my GP today but I'm afraid to take them alongside the 2mg buprenorphine having looked at the drug interaction sites. Have you taken them together and found it to be okay? Many thanks, as ever
Yes. When I had Buprenorphine panic attacks I took diazepam as well.I still take the occasional diazepam. I have no interactions or side effects.
Trazodone helps depression, anxiety and insomnia so you might want to ask for that.
Hi Sue - I see from Faith's details she is on apixaban (blood thinner). This should not be combined with Trazodone as it could make a bad bleed more likely. I know from my own situation as I wish I could take it but the risk is too great.
Good point. I will mention that to her
Thank you for bringing this to my attention, Jelbea 🙏
morning! When I came off Ropinirole 8mg a day after 15 yrs, I was given gabapentin 300mg 3x a day. I did suffer with withdrawal symptoms but I didn’t suffer as bad as some people. The gabapentin did work initially but after a year and an appt with a neurologist (privately), I’ve since found out from my neurologist that the gp has been giving me too much of both meds, hence the quick augmentation. I hope this makes sense? X
900 gabapentin is not too much. The usual effective dose is 1200 to 1800 mg.
Perhaps it’s different in the USA to the ways of our GPs and Specialised Neurologists in the UK. I’m happy with my support from Dr Simpson so far. Let’s keep our fingers crossed and watch this space. Forever hopeful x
Weaning off ropinerol is a a miserable task. There is no count of how many have been severly injured by this thing that is causing you so much trouble. Many of us have had the same aweful experience. I do not mean to dismiss your suffering but there is no easy way. The trauma, the insomnia, the 24/7 full body symptoms are common. These last 3-4 days. I cut my pills into 4pcs and reduced my dose by 1/4 pill every 7 days. For me that was a 0.25mg reduction every 7 days. Do you have a friend who can stay with you through this trauma.
Did you mean 25 mg? If so even that is too fast as the usual reduction is 25 mg every 2 weeks.
Your depression and RLS could be down to your diet. youtu.be/nkFvjNzpWSY?si=4C7...
just wanted to say , that I struggled with panic attacks , anxiety etc when I came of pramipexole, as hard as it is now , believe me when I say , it does get better , be kind to yourself . Xx
Thank you 🙏
Jelbea pointed out that if you are taking apixaban that you should not take trazodone.
Thanks, Sue - I've been given 2mg diazepam by my doctor but am terrified of taking them alongside the 2mg buprenorphine having read the information about interactions. Do you have any knowledge about that that might help me? Many thanks as ever.
The diazepam has a long half life of 48 hours versus 12 hours for the lorazepam so if you are sleepy the next day the lorazepam would be better.
If the buprenorphine is not causing drowsiness nor respiratory depression, there should not be any problem with taking both together but just be alert to this.
In the US, RLS specialist recommend adding treatment, usually gabapentin enacarbil, to get the RLS symptoms under control. Once RLS is under control, THEN begin a very slow taper of the DA. Gabapentin enacarbil is better than gabapentin as it absorbs best and maintains consistent blood levels. It is taken in the evening, the same as DAs are taken.
youtu.be/h5Hyhmxli54?featur.... Winkelman presentation
This presentation is by Dr Winkleman of Harvard and working at Boston Mass Hospital. My doctor works with him in RLS research. They recommend a very slow taper. Sneak away from the DAs.
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