Medication causing Apathy?

Use this section to discuss your experiences with prescription drugs, iron injections, and other medical interventions that involve the introduction of a drug or medicine into the body. Discuss side effects, successes, failures, published research, information about drug trials, and information about new medications being developed.

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Polar Bear
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Re: Medication causing Apathy?

Postby Polar Bear » Thu Sep 13, 2018 11:17 am

It is beyond frustraton when what seems to have been working decides to be difficult and leads to the dance of the medications. Well done that you have definitely found it is the methadone that is causing your apathy.

I take an RLS meds cocktail of relatively low opiods plus ropinerole, I thought. Seems the GP doesn't think they are low.
Last visit with my GP I asked could I have the Codeine 30mg phosphate in place of the Cocodamol (to take the paracaetamol away from my organs). She had no problem with this, codeine phosphate 30mg x 4 times daily. I discussed that the regular prescription Codeine quota wasn't just enough, that sometimes I would need an extra Codeine (or two) for breakthrough, and also there is the enforced confinement of movies or theatre where something extra is needed, the result being that I sometimes run short. So my previous CoDyd has been replaced with the C/phosphate plus some extra which she hopes I will not fully need.
GP was not happy that I was taking Tramadol ER together with the Codeine and would like me off the Tramadol ER. So from Tramadol ER 50mg x 2 daily, I am dropping one on alternate days. Last year I had weaned myself from 100mg capsules to the 50 mg capsules without great difficulty, because of side effects (I was getting random jerks).
Two weeks now into the reducing of the 50mg and wanting to take it slowly .... I am certainly feeling much more symptom breakthrough but will work at keeping the Tramadol ER lower and try to lower it further. I may ask for ordinary Tramadol in place of the ER in order to reduce the dosage in smaller steps.

My point is that my GP thinks this is a lot of opioid, can't imagine how she'd feel about me wanting a stronger opioid, and about some of the doses that we here on this site know is definitely needed. Several years ago I'd mentioned, just in conversation to one of the other Partners, about the use of methadone. You'd have thought I was talking about Crack Cocaine!!

Steve, I do hope that the Tramadol ER works for you. The grey day apathy is not a good friend.
I hope you continue to enjoy some long naps and get back to a good sleep routine.
Betty
http://www.willis-ekbom.org/about-rls-wed/publications
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation

legsbestill
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Re: Medication causing Apathy?

Postby legsbestill » Thu Sep 13, 2018 11:19 pm

It’s great that you are so proactive, Steve. I hope the tramadol er affords you some good sleep. It sounds like you could do with it.

Rustsmith
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Re: Medication causing Apathy?

Postby Rustsmith » Thu Sep 13, 2018 11:55 pm

Legs, I don't have much choice other than to be proactive. The ability of the medical community in my town to provide treatment for RLS is just about nil. I also need to try to stay as active as I can for as many years into the future as I can since my wife's MS means that I have to handle most of what is required to manage both of our lives.

Last night was my first night on Tramadol ER. Although I got "just" 5 hrs of sleep, that was as much as the previous three days combined. The best part was that my RLS was mostly under control because the previous two nights were the worst that it had been since before I started any treatments. Even during my months of augmentation it never got that bad. At one point, I realized that I had to stop walking around because I woke up as I started to fall. I had a head injury last year due to a nighttime fall, so that definitely scared me.

As for the limited number of hours of sleep last night, I am hoping it was because I followed my doctor's recommendation at took the tramadol at bedtime. I was having to take my methadone at lunch due to alerting, so I am pretty sure that is why I could not fall asleep last night until about 2:30A. Tonight will tell. I also intend to add THC back tonight. I had stopped it 2 weeks ago to make certain that it was not the THC that was causing my apathy.

Finally, my doctor asked me to see a mental health professional to try to address any non-medicine issues. So, I will be seeing my PCP next week to request a referral. I don't expect much in this since I have had depression issues since my teens that are usually mild. But I have to dot all the i's and cross the t's to satisfy my doctor that I am doing everything she asks. I'll just have to wait to see where that leads.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

curqlink
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Re: Medication causing Apathy?

Postby curqlink » Fri Sep 14, 2018 2:49 am

Good luck with the tramadol. I've never needed the ER version but its been a part of my nighttime cocktail for years. I've never had any problems with side affects or tolerance with it. I have recently found out not to take Kratom anytime close to taking tramadol however. It seems they cancel each other out and neither works worth a crap.

Rustsmith
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Re: Medication causing Apathy?

Postby Rustsmith » Sun Sep 16, 2018 6:59 am

One final thing that I forgot to add to my previous post. I asked my doctor if she would put me on dipyridamole. She declined my request and said that the size of the clinical study was still too small. But then she reported that their research group has started to look for funding for a study to investigate the use of DBS (Deep Brain Stimulation) on RLS. She asked me to let them know if I heard of any potential sources of funding, other than the Foundation, so I told her I would let her know if I found anything while at the patient conference in San Diego.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

Brynmr
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Re: Medication causing Apathy?

Postby Brynmr » Sun Sep 16, 2018 6:53 pm

Rustsmith wrote:So, my question to others is - have you experienced anything like this with long term treatment with an opioid? If so, what did you do?


I experienced clinical depression that lasted 3 months many years ago and unrelated to drug use. What you've described here sounds to me a lot like a version of clinical depression. Just a thought.

Rustsmith
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Re: Medication causing Apathy?

Postby Rustsmith » Sun Sep 16, 2018 7:49 pm

I experienced clinical depression that lasted 3 months many years ago and unrelated to drug use. What you've described here sounds to me a lot like a version of clinical depression.


That is why my doctor requested that I see a mental health professional, partly because I had a medication induced even 2 yrs ago that had me so depressed that I was near suicide. However, the apathy lifted as soon as the methadone began to work its way out of my system and has not returned even though my RLS insomnia is still out of control on my new meds.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

ViewsAskew
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Re: Medication causing Apathy?

Postby ViewsAskew » Mon Sep 17, 2018 6:27 am

Rustsmith wrote:
I experienced clinical depression that lasted 3 months many years ago and unrelated to drug use. What you've described here sounds to me a lot like a version of clinical depression.


That is why my doctor requested that I see a mental health professional, partly because I had a medication induced even 2 yrs ago that had me so depressed that I was near suicide. However, the apathy lifted as soon as the methadone began to work its way out of my system and has not returned even though my RLS insomnia is still out of control on my new meds.


Hope you continue to feel better.
Ann - Take what you need, leave the rest

Managing Your RLS

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

Rustsmith
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Re: Medication causing Apathy?

Postby Rustsmith » Tue Sep 18, 2018 4:13 am

Final update - I increased my dose of Tramadol ER yesterday and finally got a reasonable amount of sleep last night (6.5 hrs). I would have gotten more, but I just didn't feel tired at bedtime. Today, I feel good and have started enjoying the fact that I can experience happiness and other emotions again. I had dramatically reduced the amount of running that I had done since the first part of the year because I wasn't enjoying it and felt I didn't have anything more to prove to myself. Well, I started running again today and intend to keep it up. So, my life is starting to return to my old normal self, which had been missing for almost a year.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

Polar Bear
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Re: Medication causing Apathy?

Postby Polar Bear » Tue Sep 18, 2018 4:05 pm

Wonderful to hear how much improved you are. What an impact the meds have on our wellbeing.
Betty
http://www.willis-ekbom.org/about-rls-wed/publications
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation

curqlink
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Re: Medication causing Apathy?

Postby curqlink » Tue Sep 18, 2018 5:08 pm

Sometimes a person has to kick back and appreciate just feeling normal. Glad you are feeling better.

QyX
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Re: Medication causing Apathy?

Postby QyX » Wed Sep 19, 2018 4:10 pm

Rustsmith wrote: She has already indicated a willingness to switch to Tramadol, so hopefully I can get some without too much delay.


Tramadol is not a good opioid for RLS. While it might work in some cases, Tramadol is the most stimulating opioids of all opioids on the market (in my opinion). I once had a roommate who came from Syria but lifted in Dubai for the most part of his life. He hold me about his abuse of Tramadol because it was giving him energy and had stimulating effects similar to amphetamines. While not everybody has those strong stimulating effects on Tramadol, most patients seem to suffer from some kind of insomina because Tramadol is also a potent SNRi. Evidence also suggests that it can lead to augmentation. However: when you suffer from depression Tramadol still might be worth a try ... but overall I would say it is just not potent enough to treat RLS.

I highly would recommend trying a different opioid like Dihydrocodeine which is only marginally stronger then Tramadol but still a very common opioid.

Or when you want another classic opioid who is just as strong as Tramadol, regular Codeine would be the way to go.

I don't know what doctors have with Tramadol. Methadone is kinda okay ... but when it is not working and you are forced to try something else, then it must be Tramadol.

If you end up getting Tramadol, be careful with it. Never increase the dose over 400 mg in 24 hours because seizures are a more common side effect of Tramadol when you increase the dose above > 400 mg.

QyX
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Re: Medication causing Apathy?

Postby QyX » Wed Sep 19, 2018 4:16 pm

Rustsmith wrote:Final update - I increased my dose of Tramadol ER yesterday and finally got a reasonable amount of sleep last night (6.5 hrs). I would have gotten more, but I just didn't feel tired at bedtime. Today, I feel good and have started enjoying the fact that I can experience happiness and other emotions again. I had dramatically reduced the amount of running that I had done since the first part of the year because I wasn't enjoying it and felt I didn't have anything more to prove to myself. Well, I started running again today and intend to keep it up. So, my life is starting to return to my old normal self, which had been missing for almost a year.


Be aware: Tramadol is also a very potent SNRI. It has uplifting properties almost immediately. But often this effects don't last forever and you might have to settle with a more average mood. Tramadol can have weird effects on the mood. I noticed it in myself and saw it in many other normal patients and people who abused Tramadol. Not saying you will ever do it but Tramadol is just a weird opioid. Chemically it is very similar to a drug we know in Germany as Trevilor (Venlafaxine) and it wont surprise me when you get tolerant to Tramadol after a months.

But don't worry. I would expect that with every patient who has RLS.

Okay, and I admit: personally I dont like Tramadol as an opioid because it has those potent SNRI properties and is chemically close to Trevilor.

But let's see how it goes. I am curious.

Rustsmith
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Re: Medication causing Apathy?

Postby Rustsmith » Wed Sep 19, 2018 4:33 pm

At this point, I think that it is my doctor's intention that Tramadol is a temporary treatment. I see her again in January and I will not be surprised if she wants to switch me back to methadone at that time. But all that is really a guess on my part.

As for dose, I do not see any reason why I would need to increase the dose beyond my current 200mg. I went for 2.5 yrs on 5mg of methadone and never felt that I needed more.

As for the SNRI properties, in my case that could be a benefit. I struggled with depression from my teens until I started running at age 40. Running was my way of treating depression. And it worked quite well until I cut back last fall because I lost interest, most probably due to the methadone induced apathy. I have started running again, but probably will never go back to the intense training regime that I used to follow. I am getting old enough that I can still place in races without having to work at it that much. That and the fact that I have retired from running full marathons. 30 of them was enough.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

QyX
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Re: Medication causing Apathy?

Postby QyX » Wed Sep 19, 2018 4:51 pm

Rustsmith wrote:At this point, I think that it is my doctor's intention that Tramadol is a temporary treatment. I see her again in January and I will not be surprised if she wants to switch me back to methadone at that time. But all that is really a guess on my part.

As for the SNRI properties, in my case that could be a benefit. I struggled with depression from my teens until I started running at age 40. Running was my way of treating depression. And it worked quite well until I cut back last fall because I lost interest, most probably due to the methadone induced apathy. I have started running again, but probably will never go back to the intense training regime that I used to follow. I am getting old enough that I can still place in races without having to work at it that much. That and the fact that I have retired from running full marathons. 30 of them was enough.


Putting you back on Methadone sounds cruel.

When Tramadol works for you, I would just keep it as long as possible but just be prepared that the SNRI won't last forever.

While I had no such effect, the classic opioids often improve the mood too. I would say that's why they are that addictive. For Tramadol they say it is the least addictive opioid but I met some patients in the hospital (while I was working in psychiatry) who had great problems stopping Tramadol ... so much that even doctors wanted to give up on it and just prescribe it further since this seemed easier and cheaper for everyone involved.

In the end I think you can be happy for now. One of the weakest if not the weakest opioid available via prescription is improving your life dramatically. And even when it will not work out after 12 months or so, you still have many many options with the weak and strong classic opioids.

Tramadol was the first opioid I took for RLS. I was only on it for 3 days. It somewhat helped with the RLS symptoms but since I had to take max dose after only 3 days to 8 hours of relief total my doctor had no choice but to put me on Oxycodone.


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