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RLS, Depression and Anti-depressants

Posted: Wed Aug 24, 2016 3:52 am
by ViewsAskew
The following information may be helpful to those who feel they need an antidepressant. The research is a bit more positive than many of us may think. And, untreated depression is much more dangerous than the slight chance that an antidepressant might increase symptoms.

SquirmingSusan wrote:Regarding antidepressants and RLS. In online support groups, we tend to more often hear the horror stories about how these medications have worsened someone's RLS. There are individual case studies and lots of anecdotal evidence that this can happen, but there is no need for panic in relation to those medications. Someone just posted on a public RLS Facebook page that “in 98 percent of people SSRIs make their RLS go crazy.” This is just not true and inspired me to seek out and post links to what few studies are out there on the subject, and helpful information.

Basically, SSRIs may worsen RLS in a small percentage of people, and they may help in an even smaller percentage of people. Tricyclics have been linked in case reports to worsened PLMs and PLMD; but not to worsened RLS. (At least that's how I'm reading this information.) Unfortunately, lots of medical practitioners confuse the two disorders and will call PLMD RLS. They are separate, but often related disorders. Obviously anything can happen with meds, so if a particular medication makes your RLS worse, talk to your doctor. Depression is serious, and can often be treated without aggravating your RLS.

http://tinyurl.com/rls-andantidepressants (Modern SSRIs, reboxetine, and mirtazepine and their correlation to worsened RLS. SSRIs caused worsening in 5 to 10% of patients; mirtazepine in 28% of patients, and reboxetine caused no worsening of RLS.)

http://www.journals.elsevierhealth.com/ ... 7/abstract (Although there are anecdotal reports of antidepressant use causing or exacerbating RLS, systematic study of this issue fails to corroborate an association.")

There is a good brochure put out by the RLS Foundation on depression and RLS. It is here: http://www.rls.org/Document.Doc?&id=75

Finally, quoteing Dr. Buchfuhrer at http://www.rlshelp.org, in regards to treating RLS with antidepressants: "This class of medications should be used with caution in RLS patients. Antidepressants can worsen RLS symptoms more often than help them. As depression is a common problem, especially in patients with severe and persistent RLS problems, antidepressants are often prescribed for RLS patients. RLS patients who are put on antidepressants and notice worsening of their symptoms should inform their physician of this problem immediately."

Re: RLS, Depression and Anti-depressants

Posted: Wed Aug 24, 2016 7:49 am
by robertgreen99
This could explain why reboxetine caused no worsening of RLS

''Some research published in 2010, which analysed all available drug trial results for reboxetine, suggested that this drug is actually less effective for depression than a placebo (a dummy pill), and its possible harms could outweigh its possible benefits.''

Re: RLS, Depression and Anti-depressants

Posted: Wed Aug 24, 2016 9:34 pm
by ViewsAskew
robertgreen99, that seems to be true (well, see article below) for most ADs. I believe that escitalopram is one of the few that actually had statistically significant results, but could be remembering that incorrectly.

The article I've linked to below is an excellent perspective on the AD issue.

http://www.scientificamerican.com/artic ... dont-they/

Re: RLS, Depression and Anti-depressants

Posted: Thu Aug 25, 2016 7:43 am
by Polar Bear
A very interesting link above on the perspective of AD use and placebos.

Re: RLS, Depression and Anti-depressants

Posted: Tue Sep 13, 2016 3:08 pm
by Madmom02
I've been on just about every SSRI, many SNRIs, and several atypical antidepressants. Some helped the depression, some didn't. Some worsened the RLS, some didn't. The help may have been placebo but saved my life twice. The most recent may be taking my life. The last antidepressant I was on was nortriptyline, given to me because I've apparently become resistant to the SSRI/SNRI classes. It was marginally effective in helping my mood but it also raised my blood pressure to "hypertensive crisis" level. And, even though I'm off it now and have been since July 21, some damage has been done. And, I am no longer allowed to take any medicine that might raise my blood pressure, which includes most antidepressants.

If you are on an antidepressant, make sure you check your blood pressure regularly. There is some evidence that RLS can effect your blood pressure, probably because it affects how much you sleep.

Dox: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057632/
And there's more studies - you can find them through http://www.ncbi.nlm.nih.gov/pubmed?term ... cmd=search

Re: RLS, Depression and Anti-depressants

Posted: Fri Oct 07, 2016 7:28 pm
by Madmom02
Ann, just read the Scientific American article on antidepressants and placebos. Wow! This is changing my entire world view about antidepressants.

Thank you!

Re: RLS, Depression and Anti-depressants

Posted: Fri Oct 07, 2016 10:14 pm
by ViewsAskew
You are welcome!

Re: RLS, Depression and Anti-depressants

Posted: Mon Oct 17, 2016 2:31 am
by Sojourner
Ann & Susan, Thanks for posting the great links. One got a bit to "researchy" for me but the gist of all seemed to come across easily. Actually, reading the links reminded me of a question that I posted in another thread, Anxiety/Depression. The question centered around whether once an AD causes or exacerbates the RLS, does stopping the AD return the sufferer back to the status quo or does the newly initiated or exacerbated rls become the norm. I was kinda hoping that the links might address the issue but I'm thinking that they did not. If they did, then I missed it. Was anyone able to glean the answer to the question from any of the links?

Wishing all who visit here some peace this night

Re: RLS, Depression and Anti-depressants

Posted: Mon Oct 17, 2016 3:50 am
by Madmom02
I don't know of any research. In my personal experience, most antidepressants that worsened the RLS did so pretty quickly and it was bad enough that the gabapentin & later, clonazepam, couldn't cover it. Others caused a gradual worsening but it was mild enough that the gabapentin or clonazepam provided enough relief I could deal with it.

I can't be really precise but I've taken most of the SSRIs, some of the SNRIs, two tricyclics, Wellbutin, and mirtazapine.

The RLS has gotten worse over the years but I think it was a natural progression. Even on the antidepressants that caused RLS , I would have bouts when the RLS got really bad. And, I was completely antidepressant free from mid-July until about two weeks ago. From July until September, I had no RLS.

Hope this helps in some way.

Hoping for quiet legs for everyone, too!

Re: RLS, Depression and Anti-depressants

Posted: Mon Oct 17, 2016 4:55 am
by ViewsAskew
Interesting question, Sojourner. My gut tells me that many people here have had issues and have had the resolve when they stop the drug. But, I have no proof of that!

Re: RLS, Depression and Anti-depressants

Posted: Mon Oct 17, 2016 9:25 am
by badnights
I doubt there's been any research done on that topic, sojourner. Even the issue of whether baseline symptoms increase after augmenting on a DA has not been studied, as far as I know.

Re: RLS, Depression and Anti-depressants

Posted: Tue Oct 25, 2016 5:19 am
by Sojourner
Thanks for checking in on my question(s). Much appreciated. At this particular point, insomnia seems to be more of a difficulty for me than rls (knocking on wood). Neuro suggested I may want to try and AD to see if this would help the sleep pattern. Toying with the idea but as per usual don't want to muck things up. Again, thanks for the input.

Wishing all who visit here some peace this night

Re: RLS, Depression and Anti-depressants

Posted: Tue Oct 25, 2016 10:33 am
by badnights
Some of us regard the insomnia as an integral part of the disease. A number of researchers care of the same opinion, mentioning how the hyper-alertness that we have, which enables us to keep swalking and talking almost as if we;re normal after 31 nights in a row with 2 hr sleep each. Not that that helps your problem at all. Did he suggest Tramadol?

Re: RLS, Depression and Anti-depressants

Posted: Thu Oct 27, 2016 8:50 am
by Sojourner
badnights wrote:Some of us regard the insomnia as an integral part of the disease. A number of researchers care of the same opinion, mentioning how the hyper-alertness that we have, which enables us to keep swalking and talking almost as if we;re normal after 31 nights in a row with 2 hr sleep each. Not that that helps your problem at all. Did he suggest Tramadol?


He suggested Trazodone. I tried Tramadol many, many years ago but it was more for other rls symptoms rather than the insomnia. Funny, or not, but my recollection of "insomnia" seemed to come on quickly as if someone turned on the proverbial light switch. Prior to that I often lacked sleep due to rls symptoms. But, then, all of a sudden I started getting very little sleep on a daily basis even when my rls symptoms seemed to be well in check. Kinda like one step forward, two steps back. Anyway, I often think that those who have a "normal" sleep pattern don't realize how truly blessed they are.

Wishing all who visit here some peace this night.

Re: RLS, Depression and Anti-depressants

Posted: Thu Oct 27, 2016 9:43 pm
by Madmom02
Sojourner, my neurologist put me on trazadone at the beginning of this month for RLS related insomnia. Maybe my experience will help you with it.

I've gone from 25mg to 50mg to 75mg at night since I first started it. I also take .25 ropinirole after dinner and .25mg clonazepam (tapering off) immediately before I fall asleep. I've gotten 6-7 hours of sleep a few nights after the increase to 75mg and I'm increasing the dose to 100mg tonight.

The first few days after each dose increase I've been really dizzy. I've had some morning nausea but I think that's the ropinirole.

I take the trazadone with an oz of cheese or a couple tbsps of yogurt because my script says "take with food" and I think it works better. It does not make me immediately sleepy. It takes 1-2 hours to kick in and if I don't make myself try to go to sleep when it starts making me drowsy, I don't sleep until after 1am-ish - It's kinda like there's a window in which to make a serious sleep effort. On the higher doses, I've noticed I also get "hungry" if I miss that window.

I'll post again after I've been on the 100mg for a few days if you would find that helpful. Hope the trazadone helps you sleep well and long!