Open question #8: Antidepressants and WED

[Frunobulax]

Hi again,

feel free to add to the open question list yourself - the more the merrier
I'm not yet finished though. Today question: Why do most antidepressants exacerbate WED symptoms?

This is as puzzling as the relation to exercise (see question #1), but I'm not sure if the same mechanism. (Hell, and if it is, the worst that will happen to me is that I have to find a new question #8 ). Depression and WED are highly correlated. (BTW, I had my share of depressions, and whenever I felt "down" my WED symptoms were always intense.) One would expect that treating one condition should have a beneficial effect on the other, and in fact this is often true: If WED symptoms are efficiently treated, often the improved sleep quality does help with the depressions. One would expect that antidepressants are at least neutral for WED, or should even help. Yet they seem to worsen the condition. Why?

Regards, F.

[ViewsAskew]

Some of the theories I've read are about dopamine and serotonin. And, it sort of makes sense. Depression likely has a complex brain chemistry makeup. But, our ADs tend to only increase one thing - either serotonin or dopamine. And, the one AD that increases dopamine almost never increased WED.

So, does the increase in serotonin prevent enough dopamine from being used/created? Compete with it in some way? Or change the chemistry in yet another way?

[Frunobulax]

Some of the theories I've read are about dopamine and serotonin. And, it sort of makes sense. Depression likely has a complex brain chemistry makeup. But, our ADs tend to only increase one thing - either serotonin or dopamine. And, the one AD that increases dopamine almost never increased WED.

So, does the increase in serotonin prevent enough dopamine from being used/created? Compete with it in some way? Or change the chemistry in yet another way?

I wonder if this is connected to another phenomen: It appears that a lot of drugs used as antidepressants _cause_ depressions in WED patients. I myself developed severe depressions when I took lyrica, and I got severely grumpy when I took Cabergoline for a short time (a dopamine agonist). I've heard several reports from WED patients who developed depressions with Lyrica/Gabapentin, and even with Restex.

[ViewsAskew]

That would be another important question on the survey! I cannot take pramipexole without depression. And some of the opioids make me SO grumpy that I was sure my husband was going to kick me out when I was taking them! I've never been so nasty in my whole life.

[pjmccoy1]

I thought I had read somewhere than SNRI's may not exacerbate RLS as bad as SSRI's or Tricyclics? Does anyone take Cymbalta without exacerbating RLS?

[Frunobulax]

I found it interesting to revisit some of my old "open questions" from 5 years ago. They were posed when the iron hypothesis hadn't picked up as much steam as it has now - we knew that iron was a factor, but didn't know that BID is the likely cause for RLS.

So I'm curious. I made progress on some of the other topics (in my personal scope of "I have a theory that I'm satisfied with"), but I'm drawing a blank here. How does the BID theory fit with the fact that most antidepressants exacarbate RLS, especially considering that it takes a few weeks to see an antidepressant effect (higher serotonin levels) but RLS symptoms may increase immediately?

[badnights]

Others who have looked into it would probably clarify that a fairly low percentage of WED patients get worse on ADs - I don't recall the numbers people have posted nor have I come across them myself, but less than 50% and it depends on the AD - the tricyclics may have a real chance of worsening a random WEDer, but the SSRIs don't - iirc. So it may be wrong to say "most ADs".
EDIT I'm being purposely fuzzy here saying "may have a real chance of worsening". I haven't even seen the studies, so it's worse than if I had seen them and just couldn't remember.