Use of Mirtazapine worsening RLS

[cairlynne]

I’ve been taking Mirtazapine for over 5 years at night to help with my anxiety and insomnia. I have struggled with RLS symptoms off and in for about two years. My RLS symptoms have been present pretty much every night for about three months. I am thinking that the Mirtazapine is influencing these symptoms. Has anyone experienced this? If so what alternatives have you used for insomnia? I also have been diagnosed with depression in the last year and starting taking Welbutrin. Any assistance would be great.

[QyX]

Okay, so unfortunately this is a complicated issue. Mirtazapine will, like all other drugs with central histamine H1-receptor antagonism, can significantly worsen RLS. Additionally Mirtazapine also has additional central anticholinergic and serotonergic properties who can also be responsible for making RLS.

I've taken all kinds of drugs from that category, including Mirtazapine among many others and Mirtazapine was for sure one of the worst drugs for my RLS, right after the antipsychotics I tried for insomnia.

A few things to consider here:

a) did you develop generic primary RLS over the past 2 years and the insomnia you had previously was foreshadowing this development?

or

b) is it just the Mirtazapine causing the RLS symptoms?

In any case, you have to find out what is going on because this will determine what to do about your insomnia and depression / anxiety in the future. The proper way to do this would be to talk with your doctor about this and then develop a withdrawal plan for Mirtazapine.

If you have primary RLS, that would make it close to impossible for you to further take drugs like MIrtazapine. You basically have to avoid all drugs with central histamine H1-receptor antagonism. The problem with this is that the overwhelming majorities of drugs prescribed for depression / anxiety with insomnia have those properties. You can include all typical, non-typical antipsychotics and all the older antidepressants (tri- and tetracyclic) in that list. The newer antidepressants (SSRi and SNRI) will also worsen RLS because of their serotonergic properties.

Sometimes it is possible (with potent RLS medication like opioids) to take drugs that normally worsen RLS but I always only tolerated this for a couple months at most. Once it became obvious that I was reacting badly to those drugs, I wasn't able to take them ever again because my RLS responded so badly to them.

What you maybe can hope for is, that when you get proper RLS treatment and stop the Mirtazapine, your insomnia might improve so much that your depression and anxiety won't be as relevant anymore. If your insomnia and depression persists after you get proper RLS treatment, I think you will have to look into medical marijuana / cannabis since this is basically the only stuff that you can take long-term for RLS related insomnia without making everything else much worse. On a short-term basis, you can also take Benzodiazepines but with chronic insomnia it is super easy to get dependent on them and run into even bigger problems.

I can also say, based on my own personal experience, that these kinds of problem (RLS related insomnia with depression plus the inability to use all the most common drugs used to treat chronic insomnia) can make doctors go bananas and nuts because they often have a hard time accepting and believing, that such common drugs can cause such massive problems.

So no matter what, you will need to see a specialists to help you with that.

[badnights]

RLS related insomnia with depression plus the inability to use all the most common drugs used to treat chronic insomnia) can make doctors go bananas and nuts because they often have a hard time accepting and believing, that such common drugs can cause such massive problems.

Too true! So get a specialist if you can. The Foundation has a list of RLS Quality Care Centers that have gone thru the certification process and meet the Foundation's standards for knowledgeable WED/RLS care, so your best chance of getting a doctor who can deal with you is at one of the QCCs.

QyX's approach is bang-on, imo you should follow his approach and recommendations. I'm happy to tell you, though, QyX's post was a bit more pessimistic than necessary. Some people can take an SSRi or SNRI without it exacerbating their WED/RLS, so if you still need something after you and your doctor get you off the Mirtazapine, and the Wellbutrin alone isn't enough, it might worth trying some. (Wellbutrin is supposed to be WED/RLS-friendly, by the way.)

[cairlynne]

Thank you. I feel that I’ve struggled with insomnia most of my life. Even as a child. The anxiety caused my insomnia to worsen and that is why I was prescribed the Mirtazapine. The RLS started about two years ago with the symptoms being the most severe over the last few weeks. My depression has been prevalent for about a year. I feel it is related to the anxiety and insomnia. I feel helpless and dread sleep every night.
I need to discuss all of this with my doctor but wanted some insight on the affects of Mirtazapine and RLS. A sincere conversation and plan needs to be made.

[Frunobulax]

Thank you. I feel that I’ve struggled with insomnia most of my life. Even as a child. The anxiety caused my insomnia to worsen and that is why I was prescribed the Mirtazapine. The RLS started about two years ago with the symptoms being the most severe over the last few weeks. My depression has been prevalent for about a year. I feel it is related to the anxiety and insomnia. I feel helpless and dread sleep every night.
I need to discuss all of this with my doctor but wanted some insight on the affects of Mirtazapine and RLS. A sincere conversation and plan needs to be made.

There is some good news there If the insomnia causes anxiety, fixing the sleep issues might get rid of both RLS and anxiety.

My personal experience is that changing the diet makes a huge difference. A high-carbohydrate, low-fat diet can cause depression and anxiety, so I'd recommend experimenting with your diet, maybe look at a low-carb diet.

On the drug side, maybe Lyrica could help with the anxiety and insomnia? That is, get rid of the Mirtazapine. If Lyrica isn't an option, Trazodon is an older antidepressant that helps some RLS patients.