Anti depressants

[Dexterruf]

Hi, I have asked this forum this question before so forgive me my poor memory. I asked my GP for some anti depressants and his clinician prescribed Mirtarzapine. This sent my RLS into overdrive. Can anyone recommend an RLS friendly anti depressant that can be prescribed here in the UK? Many thanks.

[ChrisColumbus]

Both RLS-UK and the RLS Foundation recommend trazodone and bupropion (Wellbutrin) as RLS safe, but a few members still report problems on trazodone and bupropion can be very difficult to get prescribed for depression in the UK. It's certainly worth trying trazodone.

If trazodone doesn’t work for you, and you can't get bupropion: not everyone reacts badly to every medication that's listed as a 'medication to avoid' for most. Mirtazapine, like all tricyclics, is on that list so it's not surprising that you reacted badly to that. All SSRIs and SNRIs, including duloxetine, are also very much on the 'avoid' list, but a couple of members have recently said that duloxetine seemed OK - or at least less bad - to them.

[Dexterruf in reply to ChrisColumbus]

Thanks so much Chris. I will try those. Trouble is, you have to navigate the egos of GPs by telling them what they should prescribe...hey ho.

[ChrisColumbus in reply to Dexterruf]

Hopefully in the light of your experience on mirtazapine theyll be prepared to try you on trazodone: that's the UK available antidepressant most likely NOT to trigger RLS. Trouble is, of course, that many doctors do not see RLS symptoms as being seriously debilitating and brush us off.

(They may well knock you back on bupropion: it's only licensed (as Zyban) to aid smoking cessation in the UK. In some NHS areas, for example, bupropion may be initiated for depression by a Consultant Psychiatrist, who must have gained approval from the relevant Head of Psychiatry, and it may even then only be approved for third-line use after two previous antidepressants have been tried. In other NHS areas conditions may vary or it might not be available for depression at all. Some people have managed to get bupropion prescribed privately.)

Good luck!

[funkyday in reply to ChrisColumbus]

My doctor put me on bupropion (I'm Canadian) and I'm wondering why it is difficult to get in the UK. I've never had any issues with it. Do you know why?

[ChrisColumbus in reply to funkyday]

I can't remember the absolute detail, but I believe it was also licensed for depression in the UK but was withdrawn - possibly when there were reports of seizures at higher doses, up to I think 600mg/day. In other countries it was reintroduced at lower maximum dosages - 300 or 400mg/day - but for some reason the manufacturers did not seek to relicence for depression here. It IS licensed here as an aid to stop smoking.

It can technically be prescribed off-licence for depression here, but each NHS area can decide whether or not to allow this at all, and if so what hoops a patient has to jump through to get it.

[Nelsonmonths]

As already mentioned, I also recommend to try to get Bupropion if possible, which is also recommended in Germany and the US. If you can't get it, Trazodone and also Nefazodone and Doxepin could be a try. It is mentioned and recommended in the German RLS guideline as alternatives.

[SueJohnson in reply to Nelsonmonths]

Nefazodone is OK but Doxepin is a tricyclic anti depressant and they make RLS worse for most.

[Dexterruf in reply to SueJohnson]

Thanks Sue. Is Nefazodone same as Trazodone?

[SueJohnson in reply to Dexterruf]

No it is different.

[ELLSBELLS in reply to SueJohnson]

Just check to see if Nefazodone is available again in UK as was withdrawn several years ago due to problems with liver disease. I had my prescription withdrawn and GP gave me wrong reason for discontinuation but Dr. Google supplied the answer.

[SueJohnson in reply to ELLSBELLS]

Good point. I checked and it is still not available in the UK.

Thank you for letting me know.

[SueJohnson in reply to Nelsonmonths]

See my reply to Nelsonmonths