Anxiety/Depression Meds

[robertgreen99]

How do you treat anxiety/depression in RLS patients

Anti depressants make RLS worse
Wellbutrin and Trazadone are RLS friendly but are not very good
Benzodiazepine are powerful drugs that should only be used for a very short period due to addicted, dependence and withdrawal.

Do any of you suffer from anxiety and/or depression? If so what do you do?

[Rustsmith]

Anxiety and depression occur about 5 times more frequently with RLS than others. The approach that is generally taken when depression is severe enough to require treatment is treat the depression first and then try to manage the RLS. The best approach would probably be to try Wellburtin. If that doesn't help, then it would probably require trials with various anti-depressants to try to find one that doesn't escalate the RLS so much that it cannot be managed with either a dose increase of the current RLS med used or maybe a change to a different med that was stronger.

And the answer to your question about any of us suffering from depression, the answer is most definitely YES. If you do a search on depression, you will find lots of discussions on the topic.

[ViewsAskew]

How do you treat anxiety/depression in RLS patients

Anti depressants make RLS worse
Wellbutrin and Trazadone are RLS friendly but are not very good
Benzodiazepine are powerful drugs that should only be used for a very short period due to addicted, dependence and withdrawal.

Do any of you suffer from anxiety and/or depression? If so what do you do?

Not all antidepressants make RLS worse. In a study a few years ago, the worst offender (can't remember which one), worsened symptoms for about 20% of people. The others caused issues for about 1-2% up to 8%. So, at worst, 20 of 100 people with RLS would have worsened symptoms. At best, it would be 1 in 100. That is worth a try in my book!

Benzos - that's a tough one. If they work and you need them, as Steve said, you just do it. There are ways you can manage them to prevent dependence. It's what I'd do if I needed them.

Over the years, many of the member here have used ADs. Some were bothered. I would guess that the majority of us fell into ranges above where a few of us had issues but most didn't.

[jul2873]

I know that many people (not on these boards but on reddit) use kratom to manage depression, panic attacks, and PTSD. I use it because, for me, it takes care of my RLS symptoms. I also rarely to never feel depressed, so perhaps the kratom is helping me there as well. But please take care and keep in mind that untreated depression can be a fatal illness.

[Polar Bear]

robertgreen99 = I understand your concern about the use of an antidepressant.
I suffer from several other conditions as well as RLS and its related insomnia.
I did not feel I was depressed but certainly I wasn't firing on all cylinders. My own opinion was that lack of sleep was the culprit.
Several times my GP suggested that I try an antidepressant and I continuously refused.
During a GP appointment doc and I were chatting and I mentioned an upcoming holiday that I really wasn't feeling any enthusiasm for. Following further chat my doctor again said that he felt I'd benefit from taking an antidepressant, his reasoning being that I was coping with several debilitating conditions which together with the lack of sleep was a burden that might be eased.

My fear was an exacerbation of my RLS, however, doctor confirmed that if the antidepressant caused any ill effect to my RLS he would do everything in his power to work with me.
That was when I started 20mg Citalopram. Firstly, it does not appear to have had any negative effect on my RLS. Secondly, after about 3 weeks I realised that.... yippee... I'm going on holiday soon. I didn't realise I was depressed until I wasn't..... if you get my drift.

My Citalopram is now down to 10mg, and I will confirm that I'm very glad my doctor persuaded me to try them.

[stjohnh]

I take Cymbalta, has theoretical risk of worsening RLS, doesn't for me.

[ViewsAskew]

I recently tried escitalopram - no issues for me. Well, not with RLS/WED. I did immediately find donuts to be required 3-4 times a day, lol, but that is a different issue .

[robertgreen99]

I must be med sensitive.


I have tried 2 SNRI, 1 SSRI and 1 Tricyclic. The SNRI and SSRI made me a lot worse. The Tricyclic made me slightly worse.

[ViewsAskew]

Must be very frustrating!

I have had depression on and off for several years. Once it was related to vitamin D deficiency. The others, I think, were all related to the drugs we take. Many of them trigger mild to moderate depression. When I stop the drug, the depression stops. One time I did use an AD - it seemed to help and did not worsen the RLS - but it triggered compulsive eating.

Sometimes it feels that our "wins" are few and far between, doesn't it?

[Sojourner]

In cases in which AD's have resulted in a worsening of rls symptoms, do the increased symptoms then decrease once the AD is stopped? Or, do the increase in symptoms linger or result in a permanent increase in rls symptoms?

Wishing all who visit here some peace this night

[badnights]

@sojourner: I haven't heard that it's permanent. I think people go back to their baseline. But I haven't paid a lot of attention. It's a good question, maybe someone else has more info or personal experience

[saptree]

I've taken Zoloft for 9 years but had RLS become a chronic, daily issue 5 yrs ago. Where I would love to blame Zoloft for RLS, my dr says no. So the plan is to keep the Zoloft and manage the RLS. I augmented on Requip about 1yr ago after about 3 years of sucessful treatment. Now I take 5mg oxycodone at bedtime, which only covers me for half the night. I tried gabapentin. When I finally got to an effective dose for my RLS (900mg @bedtime only) I experienced EXTREME anxiety and palipitations. Reduced dose to 600 mg and that side effect went away but RLS was back. So no gabapentin for me.
Current plan is to try to reduce the Zoloft from 150mg to 100mg, take the oxy at bedtime, then take 0.25mg Requip when oxy wears off. To be honest I dont dare take Requip again. The withdrawl RLS was awful when I tapered off before.
So I'm looking for a way to manage RLS while on Zoloft. Wellbutrin is not an option, tried it, bad side effects.

Side note... Anybody end up on SSI disability from RLS?
Sherry

[Rustsmith]

The approach that your doctor is taking with your Zoloft is what is generally recommended for anyone with RLS who needs an antidepressant. You might ask to switch from oxycodone and Requip to just methadone. The half life of oxycodone is 4 to 5 hrs where methadone is reported to last from 8 to 56 hrs. Unlike the other opiates, methadone also has a little bit of effect on the brain's dopamine system.

As for disability, that is a question that is asked here rather frequently but rarely gets an answer. Applying for disability can be very difficult. The initial 2 stages are also managed by your state government, so the success rate will vary. But I can tell you that in the past, over 90% of all claims are denied at the first level. If you appeal, then about half of the appeals (this is step 2) are granted. For step 3, you have to hire an attorney and this level of appeal is heard by a Social Security judge (first level of federal involvement). Over 90% of the appeals at this stage are granted (in general). So the moral of this story is to be persistent if you really believe you have a case. The system is designed to make those with weak cases give up. Unfortunately, it can take as much as 18 months to go from first application to appearing before the judge. If you win, you get your benefits back to the time you filed your application and they pay your attorney fees. If you lose, then you are out what you have to pay the lawyer and you get nothing.

[saptree]

Thank you Steve. I have mentioned the use of methadone to my sleep doctor but he has no experience with it. The half life info you provided is useful. I may be his only patient on daily oxycodone. He does not wish to use an extended release oxy. He is a pulminologist primarily and gives out CPAPs. Heck, codeine does the trick if there was an 8 hr formulation to be had.

I would love to decrease the Zoloft but it's easier said than done.

Sherry

[badnights]

Current plan is to try to reduce the Zoloft from 150mg to 100mg, take the oxy at bedtime, then take 0.25mg Requip when oxy wears off. To be honest I dont dare take Requip again. The withdrawl RLS was awful when I tapered off before.

Steve mentioned methadone, but there are also some long-lasting opioids that your doctor might be more comfortable with, such as hydromorph contin. I can't think of others right now besides oxycontin which your doc does not like and ER morphine which might not be the best opioid for RLS/WED but it certainly has been used. But there are others.

Have you considered Mirapex/pramipexole instead of Requip/ropinirole? Both are DAs (dopamine agonists). Augmentation is possible on pramipexole too, but why not go with the one you haven't augmented on yet? I don't have any solid evidence but your chances of augmenting might be lower than if you re-start ropinirole. Also, pramipexole has a slightly longer half-life. There is a long-acting version of it but it is expensive. To reduce the risk of augmentation, take oral iron supplements with vitamin C if your ferritin is less than 75 ng/ml (as long as your doctor says it wouldn't hurt you), and follow the conservative guidelines for DA dosing, which suggest a max of 0.25 mg daily of pram. or 1 mg daily of ropinirole.

I would modify your plan somewhat, considering that Requip (like pramipexole) takes up to 2 hours to take effect. If you wait til the oxy is wearing off, the DA will not kick in soon enough to help. Maybe try reversing them -take the DA 1 or 2 hours before bedtime and the oxy when it wears off (iirc, the oxy takes only 15-30 min to kick in?).

Or better still, replace the oxy with an extended-release version of another opioid, like hydromorph contin. Be aware that the ER opioid takes an hour or so to kick in but also should be good for theoretically 12 hours (though they rarely last that long in real life) . So you could take the DA 2 hr before bed and the ER opioid at bedtime for the longest relief.