Restless Legs Syndrome (RLS) Discussion Board

All, I appreciate any input you have regarding how methadone affects mental health and how alerting it is compared to buprenorphine. I am on tramadol Er and buprenorphine currently. I also take clonazepam for mood stabilization. Buprenorphine has really helped RLS, but lately I've noticed significant depression and anxiety and cognitive decline....since I've only changed by adding buprenirphine in the last 4 months, I'm attributing it to the buprenirphine..(suggestions on this theory?).

My Dr has suggested switching to methadone from buprenorphine to see how it works for me. I've taken oxycodone before and it helps RLS but is more alerting than tramadol and has a significantly shorter life. Buprenorphine helps with RLS, but the life is too long as my mental function is slower during the day. I am in my early 50s and really need to think to work.

Questions regard the above....also I do suffer from anxiety. I need more sedating than alerting meds as I'm a very light sleeper....imagine that with RLS. Any advice is appreciated. I've read a side effect of methadone is anxiety.....that would be AWFUL for me and I'm hesitant to even try it for that reason.

Appreciate you guys!

There is no way to predict or know if Methadone will be more or less alerting / stimulating than Buprenorphine. It is different for everyone so the only way to know is to try it. Also Methadone is way more likely to cause depression, fatigue and insomnia than Buprenorphine but without trying, there is no way to know.

When you already feel mentally impacted by Buprenorphine, then I would be shocked if you tolerate Methadone better. Buprenorphine is also known as one of the opioids who have minimal impact on cognition and is even used for people with chronic depression, where other treatments failed. So I would be really surprised if Buprenorphine is the issue here.

However I suspect that Clonazepam is the issue here. Chronic / long term use of Benzodiazepines like Clonazepam very often leads to depression, rebound anxiety and bad / light sleep. With the long-term use of Benzodiazepine, your natural sleep is disturbed in a way that it becomes basically impossible to reach the deep sleep phase.

With Clonazepam, you have to keep in mind that it has a long half-life of approx. 40 to 50 hours. So every day you are massively impacted by it and now switching to Methadone most likely would worsen it additionally.

Please give this homepage a careful read: https://www.benzo.org.uk/manual/index.htm

And also read this: https://en.wikipedia.org/wiki/Benzodiazepine_dependence (maybe even before you read the the other link)

The signs and symptoms of benzodiazepine dependence include feeling unable to cope without the drug, unsuccessful attempts to cut down or stop benzodiazepine use, tolerance to the effects of benzodiazepines, and withdrawal symptoms when not taking the drug. Some withdrawal symptoms that may appear include anxiety, depressed mood, depersonalisation, derealisation, sleep disturbance, hypersensitivity to touch and pain, tremor, shakiness, muscular aches, pains, twitches, and headache.[11]

It is honestly very very important that you know how Benzodiazepines affect your body. Only then you will be able to make an informed decision about your current situation. Also: the older a person is, the more he will negatively affected by Benzodiazepines.

How long have you been taken Clonazepam and what is current dose?

I have taken both. One of the side effects of Buprenorphine is muscle tightness and pain. Although this is not a common side effect, I experienced this side effect. It built up slowly over time and eventually became intolerable. I switched to methadone and I tolerate it much better - no alerting and much less pain. The buprenorphine was actually stronger, as I was taking a higher dose, so I am working on taking drug holidays to make the methadone work better. But you never know what side effects you will experience.

Steve

I'm very interested in this thread and/but would like to consider low dose oxytocin as a third option (for its 12 hour half life)

I would love a longer lasting opioid that doesnt cause daytime cognitive impairment.

I have also been clonazepam dependent for 27 years .
I have taken 0.75 mg for at least decade

I currently take codeine for RLS symptoms but it is to short lived and likely not strong enough
I also use medical marijuana
Other than the Lyrica I'm currently stopping I take no other medication for anything

QyX you seem to be the board expert when it comes to this stuff
My newer neurologist literally suggested buprenorphine, so I'm close to actually acquiring something stronger.
Also, my family doctor has known me about 25 years , and is willing to prescribe anything should it be deemed helpful and necessary.

Icantsleep, you are exceedingly fortunate to have a doctor who is open to suggesting buprenorphine. I know of several people with severe RLS who have tried either Suboxone or Subutex and loved how well it worked for them. I discussed it with my own doctor yesterday since I am my periodic transition between opioids (I have to switch every six months or so to minimize side effects). She was very open to the use of buprenorphine, but said that she needs something published in the medical literature to use to persuade the insurance companies to pay for it.