RLS Depression and Bupropion

[ParisianTN55]

I’ve been off Ropinorole for about 2 months. Taking Gabapentin 400 mg. Twice daily. The problem I have now is RLS in my arms. I started taking Bupropion two weeks ago for depression. Last night my arms started when I went to bed. The twitching got so bad my whole upper body was twitching and shaking. It lasted all night. No sleep until the next morning when I got 5 hours. I’m scared to take anymore bupropion. I don’t know if that’s what caused the twitching. Any advice would be appreciated. Thanks!

[SueJohnson]

Unfortunately it can be a side effect for some so I would suggest weaning off it.

It can also be a side effect of gabapentin but since it appeared shortly after you started the bupropion that is more likely,

[ParisianTN55 in reply to SueJohnson]

Thanks again Sue. I’ve been on it for 2 weeks. How should I wean myself off of it?

[SueJohnson in reply to ParisianTN55]

I would ask your doctor. or your pharmacist.

[SueJohnson]

You mention you have RLS in your arms. Is that actually the twitching or is it RLS? Since you have been off ropinirole for 2 months you shouldn't be having RLS in the daytime. It should only be at night unless it is still from withdrawal. Normally one would then only take gabapentin at night.

I may have given this to you before: If you still have RLS increase the gabapentin by 100 mg every couple of days until you find the dose that works for you.

Take it 1 to 2 hours before bedtime as the peak plasma level is 2 hours. Since you are taking 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.

According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin ."

If you take magnesium even in a multivitamin, don't take it within 3 hours of taking gabapentin as it will interfere with the absorption of gabapentin and don't take calcium nor calcium-rich foods within 2 hours for the same reason .

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 at Https://mayoclinicproceedings.org/a...

[ParisianTN55 in reply to SueJohnson]

I have been having it in my arms at night occasionally but it has been controllable. Last night it was so much worse. The twitching and shaking was exhausting and scary. I will call my pharmacist.

[sigurdur in reply to SueJohnson]

8 months after quitting pramipexole I had it occasionally in my arms.

[SueJohnson in reply to sigurdur]

Wow, you had a long withdrawal time!

[ziggypiggy in reply to SueJohnson]

Dr. AI

Yes, it is possible to have refractory Restless Legs Syndrome (RLS) even if you have never taken dopamine agonists; while dopamine agonists are often the first-line treatment for RLS, not everyone responds well to them, and other factors like severe iron deficiency, underlying medical conditions, or poor response to other medications can still lead to refractory RLS even without prior dopamine agonist use.

3 days was the longest I took a DA. Refractory just came naturally as disease progression for me.

[SueJohnson in reply to ziggypiggy]

I don't think you meant this for me.

[707twitcher]

I started getting symptoms in my arms and torso when I started augmenting on Pramipexole. Since weaning off it and being on buprenorphine, I find that when I do get break-through symptoms, they are either pretty mild and just in the legs, but more often they are more severe and are mainly in the arms and torso. These severe symptoms are worse than anything I experienced while on DAs. I'm assuming that my new "baseline" RLS is at this more severe level. A bit scary - and why I'm resigned to being on buprehorphine forever. While bupropion may indeed trigger your RLS (it did for me as well), I suspect that it's not causing your new level of symptoms. Your baseline RLS may now be at this more severe level. So finding the right meds to control your RLS is critical. I'm surprised you're getting any relief from the gabapentin since you've only been off DAs for 2 months. DA damage to dopamine receptors can linger for quite a while, making gabapentin ineffective. I'm at the 13-month mark post-DAs, and I think I'm finally getting to the point where gabapentin is doing something for me - enabling me to reduce my buprenorphine dosage.

[SueJohnson in reply to 707twitcher]

Her dopamine receptors might not have been damaged as not all are.

[ParisianTN55 in reply to SueJohnson]

I hope not. Keeping my fingers crossed.

[SueJohnson in reply to ParisianTN55]

🤞🤞🤞

[ParisianTN55 in reply to 707twitcher]

I don’t have RLS in my legs anymore. It’s in my arms and true it is worse than in the legs. I haven’t found a way to relieve it like you can for legs by walking. Gabapentin has worked pretty well for me as long as I am vigilant about the timing of my doses. I am going to up the amount I take by another 100 or 200 mg. Thanks for your response. So glad to know someone else has it worse in the arms.

[MrCrow in reply to ParisianTN55]

I have it in my arms as well. Keep a dumbell handy and do wrist curls to the point of exhaustion.

[Eryl]

Your depression and RLS could be caused by the same thing, notably systemic inflammation caused by yor diet. youtube.com/live/0NHcwscnj-...

[ParisianTN55 in reply to Eryl]

Thanks! I watched the video and ordered her book. Interesting to see if it helps.

[Eryl in reply to ParisianTN55]

If you decide to make the dietary changes do it gradually over at least six weeks as it will take the body time to adjust.