can RLS be caused by a drug addiction?

[searching_gurl]

SWIM (someone who isnt me) is recovering from 10 years of drug abuse and addiction and since quitting methamphetamine almost 3 months ago she has rarely had a good night sleep. From research on the net she first figured that the problem was akathisia as it affects more than just her legs (though it is worse in her legs). She initially brushed off RLS because of this, but after reading a lot of very informative and helpful posts on this forum she is sure that her problem is RLS.

SWIMs history includes addiction to heroin and more recently methamphetamine (past 3-4 years), and heavy use of ecstasy and GBL (GHB analogue). Over the past 10 years she has also been prescribed a range of medications for bipolar, depression, PTSD (post traumatic stress disorder) and anxiety.

The first time SWIM experienced RLS was going through heroin withdrawal. Many addicts seem to experience this during heroin withdrawal but it can be relieved with a few days of methadone & clonidine. SWIM has never heard of this happening to someone withdrawing from methamphetamine though, and it has been 3 months since she last had methamphetamine and things are not getting better.

SWIM has been taking 15mgs Zopiclone to help her sleep for the last 3 years also, but when she stopped methamphetamine and found she couldnt sleep (usually the opposite is the case) she started to heavily abuse her sleeping pills, but is seemed the more she took, the worse she slept. SWIM went to her Doctor and asked to be switched to melatonin (not registered for prescription in NZ, schedule 28 or 29) but as her Dr had never prescribed this before she wanted to try something else first and put her on Amitiptyline (tricyclic antidepressant) SWIM reacted very badly to this, it seemed she was not getting any deep sleep. SWIM was doing crazy things in her sleep like eating canned food cold, cooking dinners (wakes up to burnt food and the oven on) Front door was open one morning and she had a vague recollection of feeling hot and standing outside naked to cool down. This she assumes to be SRED (sleep related eating disorder) most likely brought on by the high doses of Zopiclone, combine that with the worsening of the RLS symptoms after taking Amitriptyline and SWIM was a mess. She was taking more pills in a semi conscious state and waking up in the bath, cause the bath was the only place she found some relief.

SWIM thought what she had might be akathisia, but she thought it was weird that there wasnt much info about this disease causing insomnia. In total desperation she returned to her Dr and asked for Clonidine and Melatonin. Her sleep improved slightly, she thought it would keep getting better but it seems to have stabalised and she is getting a few hours sleep most nights, but not every night, and finds herself napping during the day very often as it seems this is the only time she can rest and sleep easy.

SWIM had a lot of difficulty describing her symptoms to her Dr as there just didnt seem to be a right word in the english language that described accurately enough what she was/is experiencing. Restlessness just did not cover it. Torture seemed a closer word. SWIM describes it as "kicking out" "body jerks" and a feeling like her body just wanted to escape from its skin. This feeling was occuring every 30-50secs and lasted about 3 secs each time. It was never ending, SWIM could just not lie still for long enough to get any sleep at all and if SWIM did manage to fall asleep (usually straight after a bath) she would wake up within an hour or two with the same horrible thing still happening.

Currently SWIM has no regular pattern of affects. Some nights she takes 3 baths and sleeps for 5 hours, some nights only 1 hour. A few days ago SWIM even woke up at 7.30 am with the same feeling and she needed a bath just to be able to get up and do anything.

SWM is not very active during the day and spends a lot of time at a computer, she is almost constantly moving a foot or her leg back and forth while sitting, she has done this her whole life but never found it to be a problem in the past cause it did not affect sleep, and also because it relaxed her, but she thinks now that the reason it relaxed her was because her body was needing to move due to RLS and moving her legs then relieved her symptoms. SWIMs brother and mother also do this but but it doesn not affect ther sleep.

SWIM also started smoking twice as many ciggies after quitting methamphetamine and is now smoking approx 50 ciggies a day at a price of close to $200 NZ per week. She is smoking more becasue she is not as active and because she is up for more hours due to lack of sleep. But she also thinks the nicotine is contributing to her sleeplessness. Its a vicious circle.

SWIM is going back to her Dr is a few days and she is going to print out some info on RLS for her and hopefully find something more affective then clonidine and also have some blood tests for iron levels. she has decreased her Zopiclone to 11mgs per night and she stopped the Amitriptyline a few weeks ago. SWIM also very rarely eats meat and was anaemic once as a teen.

SWIMs questions are as follows:
1. Could one of the long term effects of using methamphetamine (a drug which mainly effects the neurotransmitter dopamine) be RLS
2. What blood tests should be taken by SWIM'S Dr
3. What is the best medication to start on for RLS (in NZ), SWIM cannot be prescribed with Opiates or Benzos due to past addictions

If anyone can help me here with my questions or regarding any of the other points made in this post it would be much appreciated.

Thanks,
searching gurl

[SquirmingSusan]

SWIMs questions are as follows:
1. Could one of the long term effects of using methamphetamine (a drug which mainly effects the neurotransmitter dopamine) be RLS
2. What blood tests should be taken by SWIM'S Dr
3. What is the best medication to start on for RLS (in NZ), SWIM cannot be prescribed with Opiates or Benzos due to past addictions

If anyone can help me here with my questions or regarding any of the other points made in this post it would be much appreciated.

Thanks,
searching gurl

It seems like you already know the answers to most of these questions, but briefly, yes, it seems that meth use could screw up the dopamine receptors and lead to RLS. As for blood tests, usually ferritin (stored iron) is tested in patients with RLS. And usually the DAs (dopamine agonists) are the first line of medications for RLS; although opiods seem to be highly effective. Perhaps she can take methadone? The anticonvulsant Neurontin (gabapentin) is also frequently prescribed for PLMs (periodic limb movements) and seems to have a lot of positive benefits for a lot of conditions involving brain chemicals.

Good luck.

Susan

[ViewsAskew]

Same as Susan said. Get tested for both anemia (hemoglobin) and stored iron (ferritin). If the ferritin is below 50, she should take iron supplements 325 ferrous sulfate, 3 x daily, preferably on an empty stomach and with acid (could be lemonade, orange juice, or a vitamin C tab). If her stomach can't hack this, take it with food; it will just take longer to get better.

Smoking can aggravate RLS. SWIM must know that this is just one more in a long line of addictions. Having sat through my share of __A meetings (substitute a letter - been to several), I know how easy it is to trade them off of each other. Stopping may help (then again, it may not).

Per the drugs, as Susan said, the first line drugs are the DAs. Do watch these carefully, however, as a small, tiny group of people have had problems with gambling and a few other disorders. All addictions have dopamine problems at the core - and now you're adding in more of it. However, at low doses, it's been a problem with very, very few people. If it means being able to sleep, it's worth trying. She still has the anti-siezure class, too. Not any problems with addiction with these. And, she can try Tramadol - not sure of the name in NZ. It's not an opioid, but works similarly on pain and RLS. It's not habit forming, so may be an acceptable sub. As is methadone - works great for many of us. Not sure where I'd be without it. Since it doesn't give any high, and you take somewhere between 5 and 30 mg a day, the dose isn't anything at all like what you take for H withdrawal, and stopping it is much easier.

Since SWIM reads the board, hey SWIM. Glad it was helpful to you and hope you find some relief.

[becat]

Hi to all and Welcome to the New Girl...LOL

I am so glad you brought this topic up.
About a year ago I had reason to walk too much Tv.
One night I had on the PBS Frontline program and was using it as noise really.
The topic was about Meth users, their medical condition after addiction, and what people were doing to help and stop the trade. Afterwords I just knew this would be a new class of RLS in our community. And it will end up a sadly larger group.
The show finally gets to the medical part of meth and the Brain and I really start paying attention. Seems that Meth gives you something akin to a supercharged dopamine ride. To the tune of 5-10 times ( could be off by o 1 or 2 points, sorry I did sleep some.)LOL If addicted and addicted for some time, you've have at the very least reset you body's thoughts about dopamine levels that are good and helpful. But your brain is really wondering why life is hard to sync up with, you can produce on your own what the drugs did. ever.
My thought at the time was this, how much would they really need to help, if they could be help with dopamine? Was that damage permanent? And they need us understand their own facts about this and need to be open with the doc. bout their use.
Great thread, Thank you.
Lynne

[searching_gurl]

Thank you so much for your replies, much appreciated, SWIM will take this info to her Doctor on Monday and hopefully her Dr can come up with a good solution for her. Can anyone tell me how the DA's work in the brain and how they work to help RLS? Also if this condition is a result of methamphetamine use would that mean that DA's are a better or worse treatment option for SWIM compared to the other treatment options mentioned?

SWIM knows there is no way in hell her Dr will prexcribe Opiates or benzos of any kind (inc methadone) and SWIM has heard quite a few stories of people experiencing tolerance and withdrawal from Tramadol also so she doubts this is an option. Her Dr may even think she is drug seeking to suggest it, though SWIM does not have that intention at all - she just wants to be able to sleep so she can focus on the real issus in her life, cause at the moment this is ruling everything from her mindset to her energy levels.

SWIM is hoping that her RLS is secondary due to iron levels but she is starting to think that this probably isn't the case (will wait for blood tests and results before dwelling on this though.)

ViewsAskew: Do you think your RLS was at all caused (or worsened) by your past addictions?

thx again for all your replies,

SG

[ViewsAskew]

I've had RLS since a child and it runs in the family (basically, everyone on my mother's side has it). Most of my work in the various __A places was because of alcholic parents (ACOA), alcoholic parnters (Alanon) and a penchant for food (OA) and smoking. I didn't abuse drugs or alcohol. I've read a little on addiction, the brain and brain chemistry, though, and I totally believe it can be brought on by addiction. Shoot, one dose of Ectasy changes brain chemistry - forever. Like Lynne said, when we do things (and this includes overeating) that change our chemistry, our brains have to try to reset. The research isn't complete by any means, but it appears that some of what we do is permanent. It also appears that some of it can be changed by creating new patterns. Try "The Craving Brain" by ???? for more info. It was fascinating.

I really don't know about research regarding the DAs and the type of RLS. Might try writing Dr Buchfurer and see what he knows. He knows of all the studies that come out. Go to www.rlshelp.org. Look for the Patient questions pages - go to the most recent page and find the link to write to him. It may not net much, but it's worth a try.

SWIM is lucky to have you looking out for her.

[searching_gurl]

Thanks for the reply, I have ordered the book "The Craving Brain" but when I checked your link it only gave a postal address to set up a consultation with Dr Buchfurer, not an email, maybe I was looking in the wrong place?

SWIM took my research off this site to her Dr yesterday and her Dr is keeping the info for future reference which is great news. SWIM's Dr is keeping her on the clonidine for the moment as it is helping some and maybe things will improve for SWIM once she comes off the Zopiclone completely and gives up smoking. If not, SWIMs Dr said her next line of attack would likely be with the anticonvulsant Carbamazepine (Tegretol). And as I guessed, opiates and benzo's would be the last things considered due to SWIM's addictive tendencies.

Does anyone know how long Clonidine should be taken before bedtime for maximum effect?

Thanks again,

Searching Gurl

[ViewsAskew]

On the opening page to the site, look at the bottom of the left-hand menu for "email us" or some such - it's hard to see because it's not in normal text. Just click on it and your email program will open with his addy in it.

[Neco]

There's an e-mail link on the main left frame that should put SWIM or anyone else in contact with Dr. B.

But for the sake of easiness, there should be one right on the top half of this page

http://www.rlshelp.org/rlscomp32.htm

Personally I don't see why a doctor would have a problem giving methadone to someone when it's used to treat addiction anyway, but then I'm not about to spend enough money to buy a house and waste ten years of my life in school to find out what they know either

[searching_gurl]

Thank you, I had clicked on the email link but it didnt say who the email was being sent to so I wasn't sure that was what I was supossed to do.

Also, would it be better to put the clonidine question in a new thread?

Cheers

[Neco]

Someone else might see it, in the pharmaceutical therapy forum vs. here. So it wouldn't hurt

[ctravel12]

hi searching_gurl and welcome. I am sorry for what SWIM is going through but it looks like she is trying to get help and that is wonderful. You are an excellent friend to be there for her. I hope that she is able to find the right meds to help through this rough time.

Please keep us posted on she is doing as we really do care.

[dv]

There is a Sleep specialist Phd. in Aurora, Colorado (Denver metro) who is doing research on the correlation between chemical abuse/dependency and RLS. It appears to be a revolving study, (when one ends, another begins)

I don't know much about it, but here is the clinic info.

Dr. Lawrence Scrima Phd.
Sleep Alertness Disorder Center
Aurora CO
303-671-0977

Dana

[searching_gurl]

SWIM is going to start taking bupropion next week as she thinks her RLS is due to low dopamine levels from the cessation of methamphetamine. Actually there is really no doubt that SWIM's dopamine levels are low which means this drug should theoretically help in many ways: Depression, Methamphetamine cravings, cigarette smoking cessation, weight loss (as a person with low dopamine levels need to eat more food to obtain enough dopamine to feel satisfied) RLS, energy levels, concentration etc. SWIM has high hopes for bupropion because of the way the drug works and her sureness that low dopamine levels are to blame. So how could it not work right? Any thoughts on this?

[becat]

I'm sorry I never saw this post before tonight.

About a year ago, maybe add a 1/2, our local PBS station ran a special on Meth and what the government was doing to try and stop it.

I had the TV on for noise I assume, because I listened, but wasn't totally into it until they got to the medical side of things.

I said at that time to several in the RLS community that Meth users were our next victims and to help them would be so very hard.

The most interesting fact that I learned......Meth raises your dopamine levels higher than any normal human could do on it's own,......EVER.
One doc compared it to being chased by an animal that would and could kill you, the body goes into over drive. Fright or Flight mode......but with meth the dopamine levels are raised by huge levels.

This is a damage to thier dopamine levels and totally changes fututre chemical reactions.

Any meth user (not methadone) should or needs to be honest with any RLS expert, because they would most likely not get the right treatment without this knowledge.

It's sad, but Methamphetamine ruins one's life in more than what can be seen.

Good Luck to your friend.
Lynne