New Member/RLS and Effexor vs. Wellbutrin, Celexa, Zoloft

[susanjchar]

Hi there,

I'm a 41 year old mother of two and a new member here. I can't tell you how much I appreciate the resources.

I have been taking Effexor for anxiety for several years now. My RLS has recently become much worse (in the last two years, since my son was born). I'm trying to work out if the Effexor (and its serotonin) could be making my symptoms worse (in addition to the stress of Covid, hormonal changes, etc.). I'm trying to figure out if it's wiser to switch to something like Wellbutrin (which acts on dopamine) or even Zoloft, but am not sure if these are considered "dopamine agonists"? I'm trying to avoid augmentation, if possible. I've read about a case or two of adverse affects of Celexa (an SSRI) on RLS.

Am grateful for any feedback anyone can offer.

Wishing you all a good night's sleep,

Susan

[ViewsAskew]

Hi Susan - welcome.

The short answer is: it's possible, but you cannot know unless you switch. Almost all of the ADs CAN worsen symptoms, but only do in relatively small number of us (5 to 20%, depending on the AD). The hard part is that there is no way to tell if you will be one who gets increased symptoms except trial and error.

Not exactly what any of us with depression want to hear!

Childbirth certainly can be a catalyst for increased symptoms - and yours corresponds to that.

Have you had your serum ferritin checked? That might be a better place to start for now.

[Rustsmith]

Susan, one of the treatments used for RLS is tramadol, which is a mild opioid. Many (or most) doctors do not know that tramadol is also an SNRI anti-depressant. They do not know this because the FDA will not approve using tramadol as an anti-depressant. This is important to you because there are two halves of the tramadol molecule. When tramadol is metabolized in the liver, it is split into two parts. One half becomes the opioid. The other half is essentially Effexor. This is why the prescribing info for doctors includes a black box warning not to prescribe tramadol to patients who are already taking an anti-depressant. If your doctor will do a bit of research (by checking the PubMed chemical structure for each), (s)he will find that they two meds are very closely related. And as a bit of warning since I was abruptly taken off of tramadol, Effexor is supposed to be one of the most difficult ADs to get off of. But I wouldn't be surprised if you could simply switch from Effexor to tramadol to get the benefit of both sides of tramadol. Just remember that your doctor will probably not know any of this (I have yet to find a doctor who did), so it will require a doctor who is willing to do a bit of digging and to try something different.

As for Wellbutrin, it is completely different from all the rest of the ADs. Apparently some people experience a bit of dopamine help from it, but if your RLS is severe, you will probably also need to take something along with it.