Info Bad, Good & indifferent Antidepressants for RLS Sufferers

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Hi,

I must also confess that this RLS/depression topic is a sensitive

issue for me. I was diagnosed and treated for depression before my doctor

would take my RLS complaints seriously. The result was tragic! Once I

finally received treatment for the RLS, the depression essentially ended. In

my case, there is no question that the

" depression " was the result of prolonged RLS-induced sleep deprivation. ,

52

FROM DR. ELATY'S TREATISE ON RLS:

DRUGS WHICH ARE REPORTED TO LEAD TO OR AGGRAVATE RLS

Antidepressants, particularly the serotonin re-uptake inhibitors or

tricyclics such as Elavil (Amitripyline) + Paxil (Paroxetine) and Prozac

(fluoxetine) have been reported to aggravate RLS symptoms in some.

Psychiatric drugs, i. e., haldol (haloperidol),

risperdal (risperidone); chlorpromazine (thorazine), lithium* can produce a

" RLS Like Syndrome. "

*None of these drugs should be suddenly stopped without medical advice.

Also, ANTIHISTAMINES, particularly benadryl or diphenhydramine can aggravate

symptoms of RLS. A wide variety of over-the-counter medications for colds,

hay fever, sinus, etc. will have benadryl or diphenhydramine in them which

includes, at present, Excredin PM and Actifed. Yet, in others, it seems to

help them sleep.

Also, ANTINAUSEA drugs such as COMPAZINE and PHENERGAN used in the US can

markedly exacerbate RLS symptoms. If one is contemplating surgery, see the

RLSF's Medical Bulletin dated 4/98.

Subject: RLS & Zoloft

Last week my primary care physician gave me some samples of Zoloft

(Sertraline HC1) to try since I was kind of teary and having trouble dealing

with some frustrations. I don't have the exact dosage in front of me -- but

they are probably the smallest dosage available. I take one after breakfast.

The second day I noticed that my legs began to bother me in mid-afternoon --

something I hadn't had to deal with for a while. I'm also waking up in the

early morning with jumpy/achy legs. Could there be a connection? Could the

Zoloft be aggravating the RLS? Eleanor (78) Glendale CA

HI,

I'm sure you will hear from Dr. Levin on a more professional level in regard

to the usage of Zoloft by those with Restless Leg Syndrome, but from what I

understand, this certainly has the potential to increase your symptoms.

I took Zoloft for a while last Fall and feel that my RLS got worse. Connie,

61, MD

For 1 and one half years I have been taking a.m. antidepressant called

Luvox-150 mg and Klonopin 1 mg. I take the Luvox in the am and Klonopin at

bedtime with much success.

Zoloft caused my RLS to rage out of control. I was taken off of it and my RLS

was back to " normal. " Ed--Philly

Marleen,

Thank you for your input! You're right, there is no hard and fast rule

regarding the use of SSRIs with RLS.....there are just generalities. I'm so

glad that the Prozac is working for you. I took Zoloft myself for 4 months

last year and it did not exacerbate my RLS symptoms. Connie

Hi all!

I know it has been a while since I piped up...but I've been here with you

and still read every post!

Here's the latest...Dr. L. really caught my attention with his comments

on Prozac, Zoloft, Paxil, and Luvox...the SSRI antidepressants. And it took

a lot of thinking on my part to try to pin down exactly when my RLS started

to be a problem, but I finally nailed it down to being shortly after I

started taking Prozac. So, experiment time...I stopped the Prozac and, guess

what...yep! My symptoms decreased after about three weeks.

Not gone, mind you, but much more managable! Now I'm in the midst of trying

to wrangle my MD into starting a trial of Serzone. Go figure, legs and arms

better but I'm too miserable to enjoy it! :-) Your suggestions really help

and I appreciate your advice so much! *Major hugs.* Kelley, RN

Hi Kelley. I agree about Serzone - I've been on it for over two years and it

does NOT affect my RLS. I know, the old " everybody is different " line always

applies, but I've been through Prozac, Paxil, Elavil etc. too, and they

caused more problems than they've solved. It's worth a try. My RLS dr. says

it's the only one he knows of that doesn't get the legs twitching. Good luck!

Eve, Burlington, Ont.

Hi,

Myoclonus or PLMD is the involuntary jerking of muscles/limbs (arms, head,

legs) etc. It can be associated with serious neurologigal disorders BUT can

also be caused by anxiety and ANTI-DEPRESSANT MEDICATION. My doctor did

research and yes, Prosac and other SSRI's can actually cause myoclonus or

make it worse.

I have mild myoclonus due to stress, but when I got on Paxil.....I thought I

was having seizures. My entire body would jerk and jolt -- my head would

shake and my arms would fling around....I almost bit my tongue off. My mouth

even jerked.

Three days after I got off the Paxil, it went away. Prosac/Zoloft can cause

it too....but in the case of Tourette's Syndrome -- I don't know if it's the

disease or the medication or both.

Hi gang,

I had been on Prozac for a number of months when I went to the Washington

Sleep Disorders Clinic (Washington, D.C.). Dr. Emsellem is an expert on

RLS. One of the first things she did was take me off off of Prozac as it can

aggravate RLS. I went onto Zoloft in place of Prozac, and well, my RLS did

not improve or get worse, but my depression worsened.

I have since gone back on Prozac and even increased the dosage to 40 mg/day.

There is still no perceptible effect on my RLS.

This just means that everyone is different. While my neurologist was

certainly aware of the effect that Prozac can have on RLS, when my depression

worsened and my RLS did not improve, she put me right back on Prozac.

I have also heard that if you take Prozac, you should probably not take St.

's Wort and vice versa. I dont know how other antidepressants interact

with SJW.

I have talked to several people who have both RLS and a vitamin B12

deficiency. Dr. Emsellem had my B12 level checked and it was below normal.

I take a B12 supplement now. I just started this. If I notice any effect

I'll let you know. Wishing all of you a restful night tonight, Jane

Debbie, Please think twice before you take Elavil I didn't have RLS bad until

I took them. Others in this group can tell you the same

thing. June 64, Delaware

Yo Regina,

I have found that both Amitriptyline and Prozac increase my RLS symptoms.

Both drugs have been discussed at length in this group and Dr. Levin reported

that both have been medically known to do this. I suggest that you go to

WWW.rls.org to get an exhaustive account of the drug therapies available.

My experience with antidepressants was horrible! My doctor mistook the

effects of prolonged sleep deprivation for depression and started me on

Prozac. When that didn't do anyting, he switched me to Paxil. The Paxil

really made things worse and I was not able to get any sleep at all.

By now I had gotten virtually no sleep for several months and finally by body

revolted with a total collapse. I had severe headaches for which percocet

was prescribed. Low and behold, the legs calmed down and I finally got some

sleep. It still took many months and the start of proper RLS treatment to

get me feeling half-way decent again. The moral of the story is -- beware

the antidepressants if you have RLS! -- age 52.

Hi Eleanor,

There is at least one paper in the literature describing aggravation of RLS

by Zoloft. Dr. Levin

HI,

I'm sure you will hear from Dr. Levin on a more professional level in regard

to the usage of Zoloft by those with Restless Leg Syndrome, but from what I

understand, this certainly has the potential to increase your symptoms. I

took Zoloft for a while last Fall and feel that my rls got worse. Connie, 61,

MD

For 1 and one half years I have been taking a.m. antidepressant called

Luvox-150 mg and Klonopin 1 mg. I take the Luvox in the am and Klonopin at

bedtime with much success.

Zoloft caused my RLS to rage out of control. I was taken off of it and my RLS

was back to " normal. " Ed--Philly

Just another one with input on Elavil... it made my RLS go crazy. It was

supposed to help me sleep and instead kept me up all night. The first

night... slept like a baby. The next.. .all hell broke loose. Prozac doesn't

have the same affect however. Though it doesn't help with sleeping either.

in Atlanta

Hello, what is this about benadryl????? does it agrravate rls???? (YES;

BRS!!) i felt like i needed to respond since last night i took benadryl

because i was out of ambien and ended up pacing the floors like a zombie with

the worst attack since i was on paxil. Come to think about it when i was on

paxil i was also taking benadryl at night and i have never has a worse time

in my life. should i avoid benadryl? Hal

Dr. Levin will have to give you the final word on this, but from what I have

gathered, less is better. This, I assume, is why they say

that the SSRI anti-depressants, such as Zoloft, Prozac and Paxil are not

always good for people with RLS.

We need to increase the Dopamine and decrease the Serotonin......or at least

not add any more. I will be interested in all answers on this. Take care!

Connie

I have taken the antidepressant Trazadone for RLS and sleep for about five

years now and have had good results. The Trazadone makes me very sleepy and

even when RLS is at it's worse (and PLM) I usually get to sleep in about an

hour at most.

The only side effects have been the need to increase the dosage over the

years and, in the beginning, I had to be very careful about taking with food

(as prescribed, but not always as taken! LOL!) or would have a bad

reaction...pounding heart, severe weakness, nausea, etc.

I began my dosage at 75 mg and have increased it to 300 mg without any

apparent problems. At least I usually sleep... no dreams tho! , 56 -

Female - TX

Hi Joyce,

I did a quick check on " Luvox " on www.dogpile.com (which does a simultaneous

search on several search engines). Luvox is a brand name of Fluvoxamine

Maleate, a SSRI; for more info, check out some of the listings by doing a

dogpile search yourself. There's even some personal experiences of people

using it, in case you dont hear any experiences from rlssupport list. Hope

this helps.

Restless Legs Syndrome and Paroxetine (Paxil)

Author: Sanz Fuentenebro FJ; Huidobro A; Tejadas Rivas A

Address: Dept. of Psychiatry, Hospital 12 de Octubre, Madrid, Spain.

Source: Acta Psychiatr Scand, 1996 Dec, 94:6, 482-4

Abstract: Restless legs syndrome is a frequent dyssomnia with well-known

clinical features but uncertain origin and treatment. This paper describes a

case of restless legs syndrome worsened by paroxetine. A possible pathogenic

hypothesis related to the attributed neurochemical properties of the drug is

proposed.

Several antidepressant drugs, particularly amoxapine (Asendin), have

been associated with dopaminergic activity and extrapyramidal (EPS). Few data

are available for the newer SSRI's (Serotonin Uptake Inhibitors) In vitro,

paroxetine (Paxil) shows a slight affinity for dopamine D2 receptor. The

appearance or exacerbation of EPS has been reported in monkeys and humans

treated with SSRIs, particularly fluoxetine (Prozac), suggesting a probable

direct effect on domaminergic function. Fluoxetine has also been associated

with an apparent akathisia, perhaps due to anindirect dompaninergic

inhibition.

We consider that the reported association between RLS and paroxetine

could be generated by the antidopaminergic activity of the latter, a view

which is compatible with those pathogenic hypotheses that propose

dopaminergic hypoactivity or imbalance between the serotonergic and

domainergic pathways.

Adverse Effects of Fluoxetine (Prozac) and Restless Legs Syndrome

Author: Bakshi R

Address: Department of Neurology, University of California, Los Angeles, UCLA

School of Medicine, USA.

Source: J Neurol Sci, 1996 Oct, 142:1-2, 151-2

Abstract unavailable online.

Diagnosis and Treatment of Insomnia

Author: Pagel JF Jr

Source: Am Fam Physician, 1987 Mar, 35:3, 191-7

Abstract: Insomnia is a disorder of initiation and maintenance of sleep that

results in daytime somnolence. The differential diagnosis of the various

forms of insomnia is based primarily on the history, including information

from the sleeping partner. The possibility of underlying depression or sleep

apnea must be given consideration in every patient with insomnia, because

inappropriate therapy may be dangerous in these instances. In general, the

benzodiazepines have supplanted the traditional hypnotics in the treatment of

insomnia.

Hi Clifford

Welcome aboard. Good to have you with us. The question of depression and

RLS/PLMD is probably less complicated than some psychiatrists make it. With

no figures to back me up, my gut feeling is that the majority of depressive

reactions seen in RLS/PLMD patients is secondary to sleep deprivation and the

presence of a chronic condition with no reliable treatment that is disruptive

of patient's lives.

Let this state of affairs go on for a prolonged period of time and I think

that depression is to be expected. The question is, is this reactive

depression or is this " clinical depression " with the associated implications

of brain pathology. For me, the easiest way to find out is to treat the

RLS/PLMD and see what happens to the depression, not the other way around.

Many patients with RLS/PLMD have reported feeling " normal again " after being

relieved of their RLS/PLMD by various treatment modalities.

The fear that you cite on the part of some psychiatrists has very little

basis. The manufacturer's clinical trial figures for depression as an adverse

reaction to several drugs are as follows: Permax (189 people) 3.2% Placebo

(187 people) 5.4%

Sinemet 1.3% Sinemet CR 2.2% No placebo controls reported.

Mirapex: Depression not mentioned as an adverse reaction.

One could derive from the above that these drugs suppress depression compared

to the placebo figures for Permax. But I won't push that.

I see no reason to muddy the water with antidepressants in treating RLS/PLMD

unless the case for clinical depression is blatantly obvious. Why not treat

the RLS/PLMD first and see what happens to the depression? It won't take that

long to find out and the patients will be spared the side effects of a poorly

understood group of drugs that could well aggravate the RLS/PLMD and thus

the depression. In addition to the above, I know of no decent studies that

show that dopamine-active drugs aggravate depression.

Dr. Levin