RLS AND DEPRESSION

Whether new to RLS or new to the site, we welcome you and invite you to share your history and experiences with RLS/WED, introduce yourself, and ask questions. Successful treatment starts with a solid understanding of this disease.
Sara
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Joined: Wed Sep 01, 2004 2:40 pm

Post by Sara »

Jumpy--

I had seen some information about akasthisia on-line once when researching RLS, and I was struck by the definition, just like the one you posted. Pretty wild, isn't it???

As for diet and depression, the more I read, the more I'm convinced of the important links between food and mood, even for people with clinical chronic brain chemistry problems like the one I have. Diet affects everyone, but evidently if it's coupled with a genetic predisposition to under-producing needed brain chemicals, the problems can be much worse. :roll:

As we've discussed, depression and anxiety are somewhat different "beasts", and there can be a number of different cause and effect patterns for them each. I did a little searching, and found a few suggestions of simple things you might try, while you're working on medical and psychological avenues as well. I don't know your personal habits, Jumpy, so if any of this is not relevant, I trust you'll excuse it. :)

--- Potential protein malnutrition. Eggs, fish, chicken in the skin, red meat, nuts, seeds, cottage cheese, cheese, avocado and "good" oils are among the high-protein foods that many people limit due to concerns about fat intake. According to Julia Ross, M.A. in her book, The Diet Cure. " Protein malnutrition causes brain-power outage. As the activity of the brain shrinks with dieting [low-fat, low-protein diet], the brain's mental and emotional stability can falter--- even fail. (You can recognize brain chemistry deficiency by its very specific symptoms, such as depression, anxiety, irritability, obsessiveness, and low self-esteem.) ... The four brain chemicals that dictate your moods are all derived from the amino acids in protein foods. Even non-dieters who tend not to eat enough protein can suffer from low-protein brain drain." Average adults need between 50 and 100 grams of protein daily... more when under stress or if they have a high drain on nutrients through heavy exercise, etc.

--- Tryptophan deficiency. Trypthophan is one of the first nutrients we become deficient in when our diets are not adequate. Low levels lead to depression, low self-esteem, obsessive thoughts, etc. Tryptophan levels are also affected by other chemicals in our bodies, like aspartame (Nutrasweet) which actually competes with tryptophan in our bodies. It blocks it's conversion into serotonin. Tryptophan also is necessary for our bodies to manufacture melatonin which of course helps our brains maintain a healthy body clock and good sleep patterns. Complete proteins (meats, fish, poultry, dairy, eggs) provide natural tryptophan. Turkey is well-known as a high-tryptophan food.

--- Caffiene can contribute to depression. It depletes your vitaimin and mineral levles, overstimulates and weakens your organs, and overacidifies your pH. Even relatively small amounts of caffiene can start these negative effects.

--- Essential fatty acid deficiency. Jumpy, aren't you from eastern European heritage? That's not a specific background that red flags for fat deficiency, but a lack of "good" oils in the diet can be a cause of depression, alcoholism, and many diseases. Fats are vital for energy, overall health,and cell structure. Fatty fish, extra virgin olive oil, flax oil, dark leafy vegetables, walnuts and brazil nuts, sunflower seeds are all good for you. Foods with or supplements of vitamins A, E and C, as well ast B, lecithin and selenium help your body use the good oils you do take in. Sugar or alcohol can prevent our bodies from utilizing good fats. We don't need a lot of these essential fatty acids, but we desperately need "enough."

--- Adrenal or thyroid problems. This is more complicated, but can sometimes be related to depression.

Jumpy, when I was first alerted to this sort of mood-food connection, I got IMMEDIATE improvement in both brain chemical and hormonal problems just by increasing my daily protein proportions and replacing some simple carbohydrates with complex ones. Friends who have both anxiety and depression have seen improvements as well. I have no idea if any of this would help you or not.

But in general, healthier eating seems to have all benefits and no drawbacks. It doesn't interfere with (and CAN sometimes enhance) both prescription and psychological treatments. And it can give us greater energy and strength to deal with emotional problems, stress and illness.

BIG hugs, and hopes for a much healthier, happier 2005, Jumpy!!!

Sara

Guest

Post by Guest »

Jumpy my heart goes out to you... I too suffered with Depression shortly after compleating treatment for drug addiction. The way I viewed it was that It was just another part of me that was sick and it needed to be treated. However while I was in the throws of depression it was my recolection that the only viable solution to my problem was suicide.

Today I have a hard time understanding my thought process when I was depressed. It is as if my brain is working off of another template. What I had to do was to put my trust in the people that were telling me that things would get better. Those people became my eys sort to speek. My wife .... my psycologist...close frends.

And at a time when I was at my lowest it was my dog who helped me find my way emotionally.

So Jumpy the answers come from all places....and just know that I am greatfull to have met you and proud to be a student of your life lessons.


Brady Ferguson

jumpyowl
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Change in Medication

Post by jumpyowl »

To recall: Lately my medication was as follow:

Mirapex
3x0.5 mg = 1.5 mg per day

Remeron
1x30 mg once a day (evening)

Hydrocodone (10 mg/650 mg) one a day

I started to notice that I was having more pain than usual, usually starting in the afternoon. I also found that I had occasional narcolepsy while driving longer distances. :cry:


I attributed the pain to Remeron as it causes myalgia in about 1% of the patients. I contributed the narcolepsy to Mirapex which starts giving such syndromes at or above 1.5 mg/day levels.

I decreased both drugs and were taking them at half level. That helped with the narcolepsy but not so much with the pain.

I saw my psychiatrist telling him about the myalgia. Also the fact that Remeron is boosting norephinephrine and serotonin. Actually I showed him this quotation (from So. Calfornia Support group) :

Noradrenergic and Serotonergic Antidepressants

Remeron (Mirtazapine) - This is the newest class of antidepressants. It enhances both the noradrenalin and serotonin systems. Remeron seems to have less side effects than the serotonin uptake inhibitors and the tricyclics, and it even seems to promote sleep. There are 2 case reports of Remeron causing worsening of RLS, so it should be used with caution in RLS patients.


I also showed him the description of Wellbutrin:

There is only one antidepressant drug, Wellbutrin, which has dopamine like effects, so it may benefit RLS. This however, has not been looked at systematically yet although there are some case reports of Wellbutrin helping RLS.


I also told him that I gained 11 pounds in December alone.

He did cooperate at the end and told me to continue 150 mg samples he gave me. After these samples I have to start on Wellbutrin 3x100 mg per day.

I am still taking only 0.25 mgx3 of Mirapex. So far no paresthesia.

I shall let you know about the pain and also my experience with Wellbutrin.

Just entre nous I do not think I need any more antidepressant but I will be game. You see Wellbutrin also raises dopamine level so I may not need Mirapex (or the other). Then we shall see which one is better?

Wishing everyone a Happier New Year! :D
Jumpy Owl

cornelia

wellbutrin

Post by cornelia »

A happier New Year to you too, Jumpy!

I am VERY interested in your experience with Wellbutrin. You are my guinea pig.

I was on Remeron 15 mg for energy, but my limbs went crazy. I think that in the brochure "RLS and depression" or in the Medical Bulletin 2004 Remeron isn't mentioned anymore as a drug that is compatible with RLS. Only Trazodone (made my limbs go crazy too) and Wellbutrin.
Dr Buchfuhrer from the Cal. Group says that Wellbutrin may even be helpful for RLS. So I wish you luck!

Corrie

jan3213
Posts: 1706
Joined: Wed May 26, 2004 8:46 pm
Location: Illinois

JUMPY, ANOTHER QUESTION, PLEASE-----

Post by jan3213 »

Jumpy, it's Jan

I read your above post with interest. I am on the following medications now:

Mirapex 5 mg. daily

Effexor 75 mg. daily

I have been weaned off of Klonopin. My neuro increased Mirapex to 5 mg. from 3 mg. daily. I no longer get sleepy driving. However, I have noticed a problem, occasionally, with RLS--I think it may be the Effexor. ALSO, I have gained quite a bit of weight since the time my neuro increased the Mirapex and prescribed Effexor. I don't know if the weight gain is due to the Effexor or increased Mirapex. I am going to insist my doctor take me off Effexor and prescribed Wellbutrin. Any comments, Jumpy? What do you think about a) possible corrolation between weight gain and drugs and (b) Effexor exacerbating my RLS.

THANK YOU SO MUCH!

Jan
No one is alone who had friends.

jan3213
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Joined: Wed May 26, 2004 8:46 pm
Location: Illinois

Hey Jumpy, Never Mind

Post by jan3213 »

I found out what I needed to know, Jumpy. Hope you're doing well.

Jan
No one is alone who had friends.

jumpyowl
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Hello, Jan:

Post by jumpyowl »

I have not had a chance to find out much about Effexor. Transporting my daughter to the pain doctor, takes two nights and a day! with narcolepsy and all. Today I tried provigil! It did help driving.

I am glad you found out what you needed. Is it worthwhile to share? You know I am always eager to learn!

As ever,
Jumpy Owl

jan3213
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Joined: Wed May 26, 2004 8:46 pm
Location: Illinois

Hi Jumpy, Here's the info on Effexor

Post by jan3213 »

It's Jan

I thought I would pass on information regarding Effexor, an anti-depressant which I was prescribed after I was diagnosed with fibromyalgia.

I have been on Effexor since mid-November, 2004. I will preface my remarks by saying that a lot of people take this drug with success. However, for many of us, it can have several adverse effects.

I began taking 35 mg. for week which was increased to 75 mg. the following week. That is the dosage I was on when I started having adverse effects. I might add that my neuro did not tell me that there might be adverse effects. I found out after I read several posts on immunesupport.com, a site for people with autoimmune diseases, from people who had experienced adverse effects. Some of the side effects I had included: agitation, chest pain, DEPRESSION, diarrhea, headache, skin rash all over my body, mood changes, restlesness (exacerbated my RLS), loud ringing in ears, and swelling of ankles. I also exprerienced numbing on the left side of my face, as well as my left arm.

I spoke to my neuro yesterday and he told me to go off of it immediately. I had read that you should not quit taking Effexor "cold turkey" at 75 mg. or more; that you should decrease it to 35 mg. for about a week. But, I did what he said, because the prescription I received were time release capsules and could not be cut. He woldn't listen to me! I began to have pretty bad withdrawal from Effexor yesterday afternoon. I was extremely agitated, had RLS really bad, and felt like I was going to "explode". My head hurt worse than it ever has and I became nauseated and was sick.

I'm relaying this information so that any of you who are prescribed this drug will know what the possible adverse effects are and how bad withdrawal can be, even on a relatively low dose like I was taking. I'm okay, now, but I don't know how I'll be tonight. My stomach is still upset and I don't feel "quite right". But, I do feel better than I did last night.

I think this incident just reiterates how important it is for ALL OF US to educate ourselves, not only about RLS and fibro, etc., but also about anydrugs we might be prescribed. There is a site, www.worstpills.org, which is very helpful. It is a reputable site--I heard about it on the Today Show. I will no longer blindly take whatever my doctor prescribes for me.

Jan
No one is alone who had friends.

ViewsAskew
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Post by ViewsAskew »

Jan, that sucks. I hope you get through the withdrawal soon. If I'm not mistaken, all SSRIs can have difficult withdrawal periods. A girlfriend had to take two other drugs to withdraw from Paxil and it took her months!!!!!

You are so right about not listening blindly. I've done it and said I would never do it again only to do it again. This should be my new mantra of the year: Question everything, accept nothing at face value.

Warm thoughts,
Ann

jumpyowl
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Update on medication

Post by jumpyowl »

Well, I thought it is time to give an update. With traveling back and forth it was harder to keep on time with the medication. Only today I received Wellbutrin 300 extended release but I am still on WB-150 ext. release.

Mirapex is also still at 1/2 tablet three times a day, a total of 0.75 mg.

Since I have cut down on Mirapex, my narcoleptic attacks have ceased.
I still get sleepy but I do not have the sudden loss of control.

When I will be on 300 mg Wellbutrin, I may try to stop Mirapex. Afterall, WB is also a dopamine "agonist." The myalgia (muscle pain) I had, also lessened.

I will let you know the results once I finished titrating (varying the doses).

Getting back to the EFFEXOR question, today I received an e-mail from a lady scientist (geneticist) friend of mine:

"(Jumpy) you need to go see a psychiatrist and try a drug called Effexor if you have not tried it already. Supposedly it works very well in cases like yours… depression with a restless/anxiety component. If you are depressed and also hyperactive in some ways this type of drug is supposedly quite good."

My daughter also takes it now regularly, 75 mg a day. No noticeable side effects so far.

I am glad Jan that you stopped taking Effexor. Hives almost always indicate that you are allergic TO something in the medication, so it is a red flag!
Jumpy Owl

jan3213
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Joined: Wed May 26, 2004 8:46 pm
Location: Illinois

Hi Jumpy

Post by jan3213 »

Thanks for your reply re Effexor. I'm glad your daughter does well on it. I know some people who do tolerate it very well and it seems to help them. However, I know quite a few people who have had problems similar to mine--and some evern worse.

Once again, it proves that everyone reacts completely differently to the same drug.

Good luck, Jumpy!

Jan
No one is alone who had friends.

jumpyowl
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My regimen

Post by jumpyowl »

presently:

0.25 mg Mirapex three times daily Daily total: 0.75 mg

300 mg Wellbutrin XL once per day. Daily total: 300 mg

10 mg/650 mg Hydrocodone 1x Daily total: 10 mg/650 mg


Results? Too early to tell but the myalgia is way down and and the paresthesia is well controlled even with this smaller dose of Mirapex.

It is a good thing because next week I have to fly to Tampa and I could not get an aisle seat :( .
Jumpy Owl

cornelia

depression/anxiety

Post by cornelia »

This article is new on depression and anxiety in RLS-patients.

Neurol. 2005 Jan;252(1):67-71. Related Articles, Links


"Anxietas Tibiarum" Depression and anxiety disorders in patients with restless legs syndrome.

Winkelmann J, Prager M, Lieb R, Pfister H, Spiegel B, Wittchen HU, Holsboer F, Trenkwalder C, Strohle A.

Max Planck Institute of Psychiatry, Munich, Germany.

BACKGROUND : Symptoms of anxiety and depression in patients with restless legs syndrome (RLS) have been observed. However, it is unclear whether rates of threshold depression and anxiety disorders according to DSM-IV criteria in such patients are also elevated. METHODS : 238 RLS patients were assessed with a standardized diagnostic interview (Munich-Composite International Diagnostic Interview for DSM-IV) validated for subjects aged 18-65 years. Rates of anxiety and depressive disorders were compared between 130 RLS patients within this age range and 2265 community respondents from a nationally representative sample with somatic morbidity of other types. RESULTS : RLS patients revealed an increased risk of having 12-month anxiety and depressive disorders with particularly strong associations with panic disorder (OR=4.7; 95% CI=2.1-10.1), generalized anxiety disorder (OR=3.5; 95% CI= 1.7-7.1), and major depression (OR=2.6; 95% CI=1.5-4.4). In addition, lifetime rates of panic disorder and most depressive disorders as well as comorbid depression and anxiety disorders were considerably increased among RLS patients compared with controls. CONCLUSIONS : The results suggest that RLS patients are at increased risk of having specific anxiety and depressive disorders. Causal attributions of patients suggest that a considerable proportion of the excess morbidity for depression and panic disorder might be due to RLS symptomatology.

Corrie

guest?

Thanks Corrie!

Post by guest? »

Thanks for the article. Very interesting.

Here is a link to an article which actually is a continuing education course which doctoerst supposed to attend once a year for accreditation. In my humble opinion it is very good. (one has to register but it is free).

A Practical Approach to Recognizing and Managing Restless Legs Syndrome CMEAuthors: Anil N. Rama, MD, MPH; Clete A. Kushida, MD, PhD

LINK: http://www.medscape.com/viewarticle/468433_7

The best, JumpyOwl

jumpyowl
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Hello everybody!

Post by jumpyowl »

Here is some good reading on the connection between dreams and depression. Here is the link:

http://www.clinical-depression.co.uk/Un ... ffects.htm

Depression, Dreaming and Exhaustion:
The New Link
How your thoughts affect you physically?

"Depressed people dream up to three times as much as non-depressed people."

This is a startling, and illuminating fact. And when combined with a recent breakthrough in dream and depression research by Joseph Griffin of the European Therapy Studies Institute, it gives us a clear understanding of the how depression affects us physically.

What dreams do?
If you are, or have been depressed, you may have noticed that you ruminate, or worry a lot during those periods. Typically, these ruminations are emotionally-arousing as they are carried out using 'All or Nothing thinking' (more on this later in the section) and a negative bias. That is, you have a thought and you feel unpleasant after it - anxious, angry or helpless.

The trouble with this sort of emotional arousal is that it doesn't do anything. The thought creates the emotional reaction (usually anxiety or anger) and that's it.

What this does is leave an uncompleted 'loop' in the brain's limbic (emotional) system.

Normally, the emotion would be 'played through' by action being taken. For example: You think "That's a tiger in the bushes", feel anxious, then run away. The cycle has been completed. Or, someone annoys you, you shout at them, and the cycle is completed.

(By the way, we are not advocating the 'playing out' of anger as a therapeutic technique. All that does is makes people more angry!)

But what happens when the cycle doesn't complete?

When these emotionally arousing introspections remain incomplete at the onset of sleep then the brain needs to 'do something' with the emotional 'loops' that have been started.

What it does is create scenarios that allow those loops to complete. We call them dreams. The dream acts out, in metaphor, a situation that will allow the emotional loop to be completed and therefore 'flushed' from the brain. In other words, an imaginary experience whose pattern resembles the 'real life' one enough to create the same emotional reaction.
Normally, this does its job, and everything stays in balance.

Key Understanding
Dreams and Depression

When unfulfilled emotional arousal remains in the brain's limbic system at sleep onset, the brain creates scenarios that allow those loops to complete.We call them dreams.

The dream acts out, in metaphor, a situation that will allow the emotional loop to be completed and therefore 'flushed' from the brain.
In other words, an imaginary experience whose pattern resembles the 'real life' one closely enough to create the same emotional reaction.
For example, during the day you worry about what someone has said to you, thinking that they were perhaps criticising or making fun of you. That night you have an anxiety dream where someone stabs at you with daggers and you try to run away. The dream allows your system to complete the loop started by the emotional arousal.

What dreams do?

If you are, or have been depressed, you may have noticed that you ruminate, or worry a lot during those periods. Typically, these ruminations are emotionally-arousing as they are carried out using 'All or Nothing thinking' and a negative bias. That is, you have a thought and you feel unpleasant after it - anxious, angry or helpless.

The trouble with this sort of emotional arousal is that it doesn't do anything. The thought creates the emotional reaction (usually anxiety or anger) and that's it.

What this does is leave an uncompleted 'loop' in the brain's limbic (emotional) system.

Normally, the emotion would be 'played through' by action being taken. For example: You think "That's a tiger in the bushes", feel anxious, then run away. The cycle has been completed. Or, someone annoys you, you shout at them, and the cycle is completed.

(By the way, we are not advocating the 'playing out' of anger as a therapeutic technique. All that does is makes people more angry!)

But what happens when the cycle doesn't complete?

When these emotionally arousing introspections remain incomplete at the onset of sleep then the brain needs to 'do something' with the emotional 'loops' that have been started.

What it does is create scenarios that allow those loops to complete. We call them dreams. The dream acts out, in metaphor, a situation that will allow the emotional loop to be completed and therefore 'flushed' from the brain. In other words, an imaginary experience whose pattern resembles the 'real life' one enough to create the same emotional reaction.
Normally, this does its job, and everything stays in balance.

Key Understanding
Dreams and Depression

When unfulfilled emotional arousal remains in the brain's limbic system at sleep onset, the brain creates scenarios that allow those loops to complete.We call them dreams.

The dream acts out, in metaphor, a situation that will allow the emotional loop to be completed and therefore 'flushed' from the brain.
In other words, an imaginary experience whose pattern resembles the 'real life' one closely enough to create the same emotional reaction.

For example, during the day you worry about what someone has said to you, thinking that they were perhaps criticising or making fun of you. That night you have an anxiety dream where someone stabs at you with daggers and you try to run away. The dream allows your system to complete the loop started by the emotional arousal.
Jumpy Owl

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