Psychotic withdrawals from Pramipexole?

[tessnelson]

I was taking .25mg of Pramipexole once in the evening when I started to augment. My doctor had me stop the Pramipexole cold turkey and start taking 5mg of methadone the same day. I've only had a couple signs of RLS and I have slept well in the two and a half weeks that I have been taking the methadone, which is wonderful. The flip side of that, and great concern, is that on my third night of changing meds, I woke up with irrational fears to the point of thinking about going to the hospital because I was afraid I was going insane. I spoke to the doctor the next morning and he said it could either have been caused by withdrawal from Pramipexole or the methadone. I haven't been as psychotic as the one bad night since then but am still having a lot of negative thoughts, feeling that I am at the end of my life as I have lived it and not much joy. Many people write about the horror of no relief from RLS and no sleep for days on end. I haven't read anything from people withdrawing from dopamine agonist drugs talking about having psychotic reactions to withdrawals. My doctor is suggesting that I change to another opiate, but if it is the Pramipexole withdrawal, I would like to stay on the methadone. Has anyone experienced this kind of reaction from agonist withdrawals or beginning an opioid? Would love to hear from your experience. Thank you

[Rustsmith]

I had issues while on methadone, but not as quickly as you did. The first time, I came very close to suicide, but we figured out that it was the combination of an opioid plus extended use of a marijuana edible with THC. I was using the marijuana as a sleep aid and it was/is very effective for that purpose. I now know that I can only use it about 50% of the time.

I later realized that methadone had slowly caused me to become extremely apathetic. I didn't care about anything at all. No joy, no emotional pain, nothing. I asked my doctor to put me on Tramadol ER. Tramadol isn't used as frequently for RLS because it is the only non-DA that can cause augmentation. I have been on it for 11 months and have asked my doctor to allow me to switch back and forth between methadone and Tramadol, probably around six month intervals. I see her again in three weeks and hope to get that resolved at that time.

One thing that I learned about Tramadol is that it is also has anti-depressant properties. When I mentioned this to my doctor, she looked confused and simply said, "well, it isn't used for that purpose". That doesn't change the fact that during the time that I have been on Tramadol, I haven't had the issues that methadone caused. As an added benefit, Tramadol is a Sch. 4 medication when all the rest of the opioids are Sch 2. This means that there are far simpler (less paperwork) to actually get the medicine in your hand.

[tessnelson]

Thank you for sharing your methadone experience. I will pay attention to any feelings of apathy per your experience. I am not using any form of marijuana, but I now am feeling more open to changing methadone to another opiate.
I was given Tramadol as an emergency backup, such as air travel, and only used it a few times. The first couple of times I used it I felt a bit euphoric but not the later times. I was told to not take it when I started the methadone.
Now I am thinking I should widen my subject to psychotic experiences on methadone. Think I will check out the discussion board.
Thank you!

[QyX]

@tessnelson: have you ever had any psychotic symptoms before this incident? and do you have relatives who had a psychotic episode at one point? It is quite possible that your symptoms are in some way related to Pramipexole, however personally I don't believe the exact cause for the symptoms is that you stopped Pramipexole. To me it is more likely that the long-term usage of Pramipexole, the sudden stop and maybe even the addition of Methadone changed your brain chemistry in a way that you were experiencing those symptoms.

It is a very good sign you were able to determine that these symptoms are of psychotic nature. Really good! Most people who experience such symptoms can not make the connection. So you really want to do everything in your power to not worsen the symptoms. If it gets worse you might need antipsychotics, which are a pure nightmare to take when you have RLS. You do not want this to happen to you.

About Methadone: I would go with the recommendation of your doctor and change the opioid. If you can sleep with Methadone, you will most likely be able to sleep with any other potent opioid. I would recommend Morphine since it seems to cause the least problems with alertness. Other options are Oxycodone and Hydromorphone.


@Steve: have you tried taking a small dose of CBD every morning? I've made a similar experience that THC can cause anxiety and related problems. So when I started using Cannabis as medication for my RLS, the prescribing doctor made me take one month CBD before the THC got added later on tho avoid such problems. And at least for me this is working out.

[tessnelson]

I have only had one anxiety attack in my life and my recent experience wasn't that. It was weird because my body felt very calm but I couldn't stop the crazy thoughts. Didn't think about it, but now that you mentioned it, I was lucky that I knew my thoughts were irrational. Going to the hospital was my fall back if I started to think they were rational or I couldn't take it any more.
I think Oxycodone is my next course on the menu. Thanks for your reply.

[QyX]

Okay, you want to have an open eye for other possible other psychotic symptoms in the future. I am not saying that this will happen but it might ... and when it happens, it is just important that you get help early so that you can avoid taking high doses of hardcore dopamine antagonists.

When I was younger I had a psychosis myself and I met and worked with many people who had all kind of different psychosis.

One the earliest symptoms is that fear that something is not right. When you experience this fear again, just be very careful.

And maybe update the story when you got the new opioid? It would be very interesting to see how this develops.

Thanks <3

[ViewsAskew]

I seem to recall one of the Johns Hopkins doctors asking this question long ago at the first or second RLS patient symposium or whatever it was called - it was 2004, I think. Only one person had.

That must have been a very strange experience - and seems very lucky you could tell it was no rational!

When I first started pramipexole, I had lucid dreams the entire first night. Not terrifying as I knew what it was, but very annoying in that I really wanted to be unaware and sleeping!

[Frunobulax]

I had withdrawal from Pramipexole too, I was on 1mg a day and stopped cold turkey. Mood swings, from depression to high and back in a day. Nausea, sweat outbreaks, I felt hot and cold at times, probably some more things I have forgotten. After 2 weeks only the depression stayed, and it took roughly 2 years until I had that under control.

I wonder why even specialized RLS doctors don't know about it, if you google "dopamine agonist withdrawal" you get some documents that describe pretty much what I experienced.