Can Adult ADHD cause RLS

[tomj83969]

I am experiencing significant sleep disorders/issues - RLS, insomnia, daytime drowsiness, and mild depression, particularly in the mornings.

I have been reading recently about adults with ADHD Attention Deficit Hyperactivity Disorder reporting high symptom levels of troubled sleep, restless legs. (https://www.frontiersin.org/articles/10 ... 01621/full is one example). Years ago I was diagnosed with adult ADHD - primarily due to attention difficulties. I was treated with Methylphenidate at the time, but for some reason I don't remember I no longer take it.

My question is: can restarting the methylphenidate therapy improve my sleep disorders - primarily RLS? For the record I am 77 years old.

Thanks for any help you can offer me. I am truly in need of assistance and guidance.

Tomj83969

[stjohnh]

Hi Tom, Wecome to the forum. Interesting article you cite. I don't know much about adult ADHD, but all of thesymptoms you report can simply be due to RLS. I have no idea if restarting the methyphenidate will help. Why not ask your doc for 10 tablets or so and try it? It will help us understand your situation if you can tell us about your RLS symtoms and what medicine you currently take.

[tomj83969]

Thanks for responding, Holland. I have asked my Primary Care Physician for a month's worth of tablets (30 5mg pills) as a trial to see if Methylphenidate has any affect. I will be seeing him on May 12 to find out if he will prescribe the month trial. I am also talking to our Sleep Clinic that same day. I will let you know the results!

I am currently taking Ropinirole - 3.5mg per day. The maximum RLS dose is 4 mg per day. I have been taking Ropinirole for over 15 years ... so I am worried about augmentation as well as the fact that I am approaching the daily limit for RLS treatment.

Again, thanks for your interest and I'll post a reply as soon as I know something.

Tom

[stjohnh]

I am currently taking Ropinirole - 3.5mg per day. The maximum RLS dose is 4 mg per day. I have been taking Ropinirole for over 15 years ... so I am worried about augmentation as well as the fact that I am approaching the daily limit for RLS treatment.

Tom, the dose you are taking, while ok as far as the FDA is concerned, is higher than most RLS specialists feel is safe. Primarily because augmentation occurs more quickly and to more patients at higher dose levels. Most would consider 3.5mg too high. You are at high risk for augmation, and may already be augmenting.

[badnights]

I am currently taking Ropinirole - 3.5mg per day. The maximum RLS dose is 4 mg per day. I have been taking Ropinirole for over 15 years ... so I am worried about augmentation as well as the fact that I am approaching the daily limit for RLS treatment.

Tom, the dose you are taking, while ok as far as the FDA is concerned, is higher than most RLS specialists feel is safe. Primarily because augmentation occurs more quickly and to more patients at higher dose levels. Most would consider 3.5mg too high. You are at high risk for augmation, and may already be augmenting.

And in fact if you are augmenting, it's no wonder you can't sleep well and are depressed. There is a paper you can access via the link in my signature below this post, Buchfuhrer's 2012; he suggests the maximum ropinirole dose for WED/RLS patients should be 1 mg.

Reducing from 3.5 will probably involve a lot of worsened symptoms for a while. The aim of reducing will be to stop it entirely. The question then arises of what to replace it with. This is where you really should have a doctor who is experienced in treating augmented WED/RLS. Usually only opioids work, at least initially, but it is always best to combine two classes of meds to keep the dose of each med as low as possible.

One thing that could make the transition off ropinirole easier is getting your iron level up. WED/RLS is essentially an iron deficiency of the brain. There is no easy way to measure brain iron directly, and most doctors don't realize that each organ of the body has its own iron level that is distinct from the level in the blood, the only easy one to measure. Nevertheless, if the amount of a protein called ferritin is low in your blood, it means you have a deficit of iron somewhere in your body. So your doctor should order iron blood work (including iron, TIBC, saturation index, and ferritin). If your ferritin is below 100, you qualify for an iron infusion, according to the 2018 consensus guidelines for treatment of WED/RLS with iron. That link is in my signature, too: The 2018 ... IRON TREATMENT for WED/RLS

There are some anecdotal suggestions that for some people, methylphenidate can reduce WED/RLS symptoms. Try reading some of QyX's posts, do a search for Author = Qyx and Keyword = methylphenidate . Definitely worth a try.

[badnights]

From http://www.medicalnewstoday.com/releases/215590.php

Early Iron Deficiency Damage May Be Eased By Ritalin

Article Date: 04 Feb 2011 - 1:00 PDT
Selected extracts - see link above for full news article
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Ritalin may help improve brain function in adolescent rats that were iron deficient during infancy, according to a team of Penn State neuroscientists. This may have implications for iron-deficient human infants as well.

The researchers found that low doses of Ritalin can help improve the focus of iron-deficient rats. Higher doses proved to hurt rather than help the control animals' focus, making them hyperactive. The control rats that were not iron deficient but received low doses of Ritalin showed no positive or negative change in performance.

When children are deprived of iron at any point during the last trimester of pregnancy or the first six months of life - a critical period of brain development - they suffer brain damage at least through early adulthood, and possibly beyond. In particular, their motor function can be impaired as well as their ability to focus.

Children with iron deficiency can exhibit attention problems, attachment issues and motor problems, said Byron C. Jones, professor of biobehavioral health.

Iron-deficient adults often have restless legs syndrome. People who become iron deficient after three years of age can recover by taking iron supplements.

...

Iron-deficient adolescent rats were treated with methylphenidate, commonly known as Ritalin, to see if the drug would help the animals overcome the deficit, as reported in this quarter's issue of Behavioural Brain Research.

"Most of the research community knows that iron deficiency has a major hit on dopamine systems," said Jones. "Why hasn't anybody tried a dopamine drug to repair or at least rescue some of what's lost?" Ritalin is a drug that helps regulate levels of dopamine in the brain. Most often it is prescribed to patients with attention-deficit/hyperactivity disorder. Dopamine is important in controlling many important functions of the brain, like being able to sustain attention and shift it.
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