Opioid withdrawal question

[leggo_my_legs]

Hello knowledgeable RLS friends!

Lately I've been experiencing debilitating anxiety pretty much all day. It peaks around the time I get off work (I AM having a lot of work stress!). The only time I feel better is after taking my nightly dose of oxycodone 10 mg for the PMLS/RLS.

Therefore, I was wondering if I am having some kind of interdose withdrawal from the opioid? Or is anxiety relief just a pleasant side effect of the medication for my legs? I only take the 10 mg a day at bedtime. MD said that isn't enough to have withdrawal issues. But I wonder because the anxiety is severe and unremitting. I don't have other opioid withdrawal symptoms.

I am also on SSRI and I am microtapering gabapentin, but that dose is steady currently and I still have the anxiety.

[Frunobulax]

Opioids cause a low dose of dopamine production, which might influence anxiety.

But I know that I've read many reports of RLS patients about paradox reactions to antidepressants and antiepileptica like Lyrica or Gabapentin. It's at least theoretically possible that your SSRI causes the anxiety, or the gabapentin (possibly the tapering of). And IIRC all these drugs are usually metabolized via the same enzymatic pathways, so they can interact in unforeseen ways (effects can be both enhancement or suppression of the effects of other drugs).

[Rustsmith]

Oxycodone has a half life of about 3 hrs, so if you are just taking it at bedtime, it would essentially be out of your system by morning. So it is unlikely that what you are experiencing is withdrawal. But you could be experiencing the early stages of RLS that isn't treated until you take the oxy again, especially since you are taking an SSRI. You might want to ask your doctor to try switching to methadone or the extended release form of oxycodone (oxycontin) to see if these would help since they would tend to last longer and might help address your afternoon anxiety (if it really is related to your RLS).

[leggo_my_legs]

Frunobulax and Rustsmith,

Thanks for your replies! I learned from both.

Fruno, I am suspicious that my antidepressant is causing the anxiety. I can't start tapering it until I'm off the gabapentin, but I am looking forward to getting off both. It will be a long journey for me since I can't tolerate fast tapers.

[Frunobulax]

Fruno, I am suspicious that my antidepressant is causing the anxiety. I can't start tapering it until I'm off the gabapentin, but I am looking forward to getting off both. It will be a long journey for me since I can't tolerate fast tapers.

It's just a possibility that I wanted you to be aware of. It's rather rare, but something that may be missed by many doctors if it happens. But for some reason paradox reactions are well known in this forum, so it could be more often for people with RLS.

I know I had depressions from Lyrica. My doctor suggested I should increase the dose as Lyrica is used as anti-depressant and anti-anxiety, luckily I changed the docter instead and tapered it, and the depressions were gone. Lyrica was designed as "better Gabapentin", faster acting and less side effects (IIRC). When I later was prescribed serotonin (supposed to "activate" me), I started sleeping 14-16 hours per day. In fact all antidepressants did nothing for me except causing side effects. (No wonder, as my later diagnosis was ME/CFS, which is not psychosomatic but often misdiagnosed as depression.)

[QyX]

So as others already mentioned, it is most likely not a withdrawal effect. What you describe does regularly happen when sometimes takes short-acting sleeping pills for a long period of time. However, as you describe it, there is certainly some kind of connection and it would interesting to explore this future.

Personally I've experienced that Pregabalin (Lyrica) can cause anxiety. I responded paradox to it and since Gabapentin is a related substance, it certainly possible that other people might react to it the same way I reacted to Pregabalin.

Also SSRi are well known to cause paradox effects. What is the reason you are taking the SSRi? Is the anxiety worse without the SSRi? Or are you taking it for depression?

Or maybe most important: can you remember how the anxiety started? Was it just random? Did it get worse over the past months?

And as others have also suggested: maybe switching to long acting Oxycodone instead of fast release will make a difference and make you feel less anxiety in the morning?

[leggo_my_legs]

Fruno, I believe SSRIs causing anxiety and a whole host of other problems is not rare, but instead gets misdiagnosed as a worsening of "mental illness," hence the current epidemic of polypharmacy...

QyX, I started taking the zoloft over a decade ago for depression. I'm only continuing on it right now to stave off the severe withdrawal I would get if I came off (speaking from experience, it was a nightmare). I will be coming off, but I've gotta get off the gaba first.