RLS because of anti-psychotics

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Tom
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RLS because of anti-psychotics

Postby Tom » Sat Mar 02, 2019 3:16 am

Wife has been taking anti-psychotics (Olanzapine/Zyprexa & Clozapine/Clozaril) for 6+ months & has restlessness in the night because of that. She takes those for schizophrenia, so she cannot stop them.

She lies down on the bed & then immediately gets up and walks around the room. Again lies down & again gets up to walk around the room. The doctor calls it Akathisia but I think it's RLS (it happens only after evening 5-6 o'clock). Has never happened in the day time. She describes it as a "pulling" sensation in her legs.

Klonopin/Clonazepam is the only thing which has worked to date. She takes a total of 2mg per day. With 2mg of Klonopin she has the restlessness only for 15-20 minutes in the night. Without it, it lasts anywhere between an hour or 5-6 hours.

Vitamin B6 doesn't help, Magnesium doesn't help, Propraronol/Inderal doesn't help, Artane/Trihexyphenidyl doesn't help.

Anyone else here suffering from restlessness because of Anti-Psychotics - what has helped for you?
Klonopin/Clonazepam more or less solves the problem but I am worried that in the long term Klonopin itself will become a different problem
Last edited by Tom on Sat Mar 02, 2019 3:44 am, edited 1 time in total.

stjohnh
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Re: RLS because of anti-psychotics

Postby stjohnh » Sat Mar 02, 2019 3:40 am

I don't really know exactly how one tells the difference between akathesia caused by antipsychotics and RLS. It does sound like to me from your description that she may have RLS. Perhaps the simplest way to tell for sure if the psychiatrist isn't sure, is to prescribe a short course of pramipexole, 0.125 mg in the evening and see if the symptoms improve. There isn't much else that will get better with pramipexole other than RLS.
Blessings,
Holland

Tom
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Re: RLS because of anti-psychotics

Postby Tom » Sat Mar 02, 2019 10:41 am

stjohnh wrote:I don't really know exactly how one tells the difference between akathesia caused by antipsychotics and RLS.


I think akathisia happens during the day also. But RLS is mostly during evenings and night. Most websites say that is the main way to distinguish between Akathisia and RLS.

Rustsmith
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Re: RLS because of anti-psychotics

Postby Rustsmith » Sat Mar 02, 2019 2:59 pm

I agree with Holland that a short term test with pramipexole would seem to be a way to determine if it is RLS. If it is, the pramipexole may very will fix it within minutes of taking the first pill. If it is RLS, them a continuation of pramipexole probably isn't the best course to take. First, her doctor should order a full set of blood tests concentrating on iron levels, ferritin in particular, which has to be specifically requested. Assuming her ferritin shows up low, them increasing it by taking iron supplements would be the next step but would take some time to be effective (if it is). There are further steps to be taken, but those can wait until later.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

Polar Bear
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Re: RLS because of anti-psychotics

Postby Polar Bear » Sat Mar 02, 2019 4:36 pm

Tom - I have had experience of living with someone who was prescribed anti psychotic medication for schizophrenia.
I always thought it was one of the side effects that he would walk up and down a room, and up and down ...and up and down. This happened all the time, day and night, if he was out of bed. The rest of the family perhaps trying to watch a movie and he would be walking across our sight line every 20 or 30 seconds.
At the same time there was a strange constant reperitive hand movement, arms hanging loosely by his sides and pulling his little finger and thumb in to meet each other in a repitition of about every 5 seconds.

I always considered this a side effect of the drugs, however having just had a look on the internet I found a comment that this behaviour is also a symptoms of untreated schizophrenia. This reminded me of just before his diagnosis when he would walk the floors at night playing the same music track loudly over and over and over ........

The 'restlessness' certainly wasn't caused by RLS because he could spend hours at a time in bed, somethimes up to 21 hours out of the 24.

I'm sorry I can't be more definitive. It's hard to tell if his 'restlessness' was part of the schizophrenia, or caused by the anti psychotic medication.
Betty
http://www.willis-ekbom.org/about-rls-wed/publications
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation

Tom
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Re: RLS because of anti-psychotics

Postby Tom » Sun Mar 03, 2019 4:02 am

stjohnh wrote:Perhaps the simplest way to tell for sure if the psychiatrist isn't sure, is to prescribe a short course of pramipexole, 0.125 mg in the evening and see if the symptoms improve. There isn't much else that will get better with pramipexole other than RLS.


Is pramipexole something which cures it or does it have to be taken for a lifetime? And any side effects/problems with taking it? It is a better drug to take as compared to Klonopin/Clonazepam?

Polar Bear wrote:I always considered this a side effect of the drugs, however having just had a look on the internet I found a comment that this behaviour is also a symptoms of untreated schizophrenia. This reminded me of just before his diagnosis when he would walk the floors at night playing the same music track loudly over and over and over ........

The 'restlessness' certainly wasn't caused by RLS because he could spend hours at a time in bed, somethimes up to 21 hours out of the 24.



My wife had zero RLS like symptoms before she started taking the anti-pyschotics. And it goes away within a day of stopping the anti-psychotics.

Rustsmith
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Re: RLS because of anti-psychotics

Postby Rustsmith » Sun Mar 03, 2019 5:17 am

Tom, there are no cures for RLS. Those of us with RLS that is not caused by other drugs or other medical conditions are currently fated to take some form of medication for the rest of our lives. There is ongoing research, but who knows if or when we will benefit and even then, we will probably be taking something forever.

As for side effects of pramipexole, there can be a number of them with augmentation perhaps being the most common. Augmentation occurs when the pramipexole stops helping and starts making things worse. Often a doctor will just up the dose, which only delays the inevitable. Getting off of pramipexole is then another story and can be very difficult.

As for Klonopin/Clonzepam, those are benzodiazapines that are sedating, but do not actually treat the RLS. They work for some, but for others they just create a stumbling drunk who cannot fall asleep. Getting off of these can also be very difficult.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

stjohnh
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Re: RLS because of anti-psychotics

Postby stjohnh » Sun Mar 03, 2019 2:57 pm

I checked further into Olanzapine/Zyprexa. It was originally developed as an alternative to antihistamines, and I couldn't find out how much antihistamine properties it has. Antihistamines make RLS worse. However, Olanzapine/Zyprexa IS known to be a dopamine blocker, which is exactly what would cause someone with a tendency to RLS to get much worse. It would also explain how come your wife gets better quickly when stopping the drug.

I think you should ask the psychiatrist about another drug to treat schizophrenia, making sure it does not have antihistamine or dopamine blocking properties.
Blessings,
Holland

Polar Bear
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Re: RLS because of anti-psychotics

Postby Polar Bear » Sun Mar 03, 2019 3:34 pm

It does indeed look like your wife's medication for schizophrenia is causing a problem and a change of medication is needed as well stated in stjohnn post above.
Betty
http://www.willis-ekbom.org/about-rls-wed/publications
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Tom
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Re: RLS because of anti-psychotics

Postby Tom » Sun Mar 03, 2019 4:17 pm

stjohnh wrote:I think you should ask the psychiatrist about another drug to treat schizophrenia, making sure it does not have antihistamine or dopamine blocking properties.



All anti-psychotics for treating schizo are dopamine blockers. That's how schizo is treated. That's why all anti-psychotics have a possibility of causing side effects like Extra Pyramidal Symptoms, Parkinsonism, RLS, Akathisia, Dyskinesia etc.

Different anti-psychotics cause different effects in different patients but most of them have to potential to cause it.

And changing medication is also a difficult process - in case the new one doesn't work, she will get her delusions & will stop taking any medication & start imagining that me & her doctor are trying to kill her. My wife suffers from a form a schizo called paranoid schizophrenia which means if she stops taking medicines & relapses, she will have to be forcibly hospitalized & treated because she will then start imagining that the whole world is conspiring against her.

stjohnh
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Re: RLS because of anti-psychotics

Postby stjohnh » Sun Mar 03, 2019 4:29 pm

Tom wrote:
stjohnh wrote:I think you should ask the psychiatrist about another drug to treat schizophrenia, making sure it does not have antihistamine or dopamine blocking properties.



All anti-psychotics for treating schizo are dopamine blockers. That's how schizo is treated. That's why all anti-psychotics have a possibility of causing side effects like Extra Pyramidal Symptoms, Parkinsonism, RLS, Akathisia, Dyskinesia etc.


Wow, looks like your wife is between a rock and a hard place. I think you should consider getting her an appointment with one of the RLS specialists in the Excellence of Care program sponsored by the RLS Foundation. Go to their web site for further info.

Assuming your wife does have RLS exacerbated by the Zyprexa, and changing the Zyprexa is not a viable option, then it seems to me that she should be evaluated for IV Iron therapy. This is the one treatment that doesn't adversely affect the dopamine system, gets at the physiological basis for RLS, and has a significant chance of helping her. RLS is caused by Brain Iron Deficiency. Likely your wife has mild underlying RLS, exacerbated by Zyprexa.
Blessings,
Holland

Polar Bear
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Re: RLS because of anti-psychotics

Postby Polar Bear » Sun Mar 03, 2019 9:54 pm

Tom, I understand totally how important it is that you keep your wife properly treated for her paranoid schizophrenia. I spent 25 years living with a paranoid schizophrenia sufferer and am aware how the smallest hiccup in medications can result in a forcible hospital admission.

Your wife is fortunate to have you fight her corner for her.
Betty
http://www.willis-ekbom.org/about-rls-wed/publications
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation


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