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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Kebby on March 10, 2001, at 19:46:35
I started taking Prozac about 9 years ago, and felt much better as a result. However, after about 6 years, I started to experience restless leg syndrome and fine hand tremors. I have tried other antidepressants subsequently, including Zoloft, Paxil, Remeron, and Celexa, and eventually have started experiencing restless leg syndrome with each one. I also take a small dose of desipramine as a prophylactic for migraines, but I am reluctant to increase this medication because of the greater number of side effects, including weight gain, with the older tricylics. I am thinking of trying Wellbutrin, and wondered if anyone had used this drug and whether they experienced the leg restlessness with it.
Posted by AndrewB on March 11, 2001, at 0:11:25
In reply to Antidepressants and restless leg syndrome, posted by Kebby on March 10, 2001, at 19:46:35
> I started taking Prozac about 9 years ago, and felt much better as a result. However, after about 6 years, I started to experience restless leg syndrome and fine hand tremors. I have tried other antidepressants subsequently, including Zoloft, Paxil, Remeron, and Celexa, and eventually have started experiencing restless leg syndrome with each one. I also take a small dose of desipramine as a prophylactic for migraines, but I am reluctant to increase this medication because of the greater number of side effects, including weight gain, with the older tricylics. I am thinking of trying Wellbutrin, and wondered if anyone had used this drug and whether they experienced the leg restlessness with it.
Mirapex has been shown to very often increase the mood benefit of SSRIs like prozac AND it is used to take away restless leg syndrome.
Ask your doctor about adding on Mirapex.AndrewB
Posted by danf on March 11, 2001, at 2:45:56
In reply to Re: Antidepressants and restless leg syndrome, posted by AndrewB on March 11, 2001, at 0:11:25
also give a try to Mg++ &/or Vit E supplements.
While they are of more help with muscle twitches & cramps, they do help some with RLS.
Posted by JohnX on March 11, 2001, at 6:28:59
In reply to Antidepressants and restless leg syndrome, posted by Kebby on March 10, 2001, at 19:46:35
> I started taking Prozac about 9 years ago, and felt much better as a result. However, after about 6 years, I started to experience restless leg syndrome and fine hand tremors. I have tried other antidepressants subsequently, including Zoloft, Paxil, Remeron, and Celexa, and eventually have started experiencing restless leg syndrome with each one. I also take a small dose of desipramine as a prophylactic for migraines, but I am reluctant to increase this medication because of the greater number of side effects, including weight gain, with the older tricylics. I am thinking of trying Wellbutrin, and wondered if anyone had used this drug and whether they experienced the leg restlessness with it.
Kebby,
I experienced really bad RLS while taking Effexor. I learned that any serotonergic medication as most of those you described can cause RLS usually by reducing dopamine in an area of the noggin. Mirapex as Andrew has suggested is a dopaminergic agent and as such is a good idea to help RLS. I found serindipidously that Klonopin helped with RLS, and with subsequent research I discovered that benzodiazepines (anti-anxiety meds like Klonopin) are helpful for RLS as well as beta-blockers such as Inderall (propranolol). The benzos are addictive. I would go with Andrew's suggestion (the dopaminergic agents) and if that isn't succesfull try the beta-blocker (it helped me). The stronger beta-blockers like Inderall have a slight chance of inducing depression. Visken (pindolol) is a more mild beta blocker and may also help with RLS, and also actually generally helps relieve depression. I haven't tried it, but would like too.
-John
Posted by Noa on March 11, 2001, at 15:08:30
In reply to Re: Antidepressants and restless leg syndrome » Kebby, posted by JohnX on March 11, 2001, at 6:28:59
Serzone helps with this most of the time, but my pdoc prescribed klonopin and also said that a dopaminergic med would also be an option. The klonopin works, but I only take it once in a while.
Posted by JohnX on March 11, 2001, at 22:46:13
In reply to Re: Antidepressants and restless leg syndrome, posted by Noa on March 11, 2001, at 15:08:30
> Serzone helps with this most of the time, but my pdoc prescribed klonopin and also said that a dopaminergic med would also be an option. The klonopin works, but I only take it once in a while.
I also thought that Serzone would be a good med that may help, but I didn't list it because I was curious about the lack of help with Remeron. I believe the serotonin 5ht-2 antagonism in Serzone (which Remeron also has) indirectly increases the dopamine in the trouble spot.
-John
Posted by LMM on March 12, 2001, at 7:08:21
In reply to Re: Antidepressants and restless leg syndrome, posted by JohnX on March 11, 2001, at 22:46:13
>
Posted by SalArmy4me on March 12, 2001, at 7:48:14
In reply to Antidepressants and restless leg syndrome, posted by Kebby on March 10, 2001, at 19:46:35
My dad only prescribes Sinemet for RLS. I don't know why I had to say that.
Posted by JohnX on March 13, 2001, at 3:03:55
In reply to Re: What is restless leg syndrome?-no post, posted by LMM on March 12, 2001, at 7:08:21
> >
RLS (restless legs syndrome) is a condition while resting (generally sleeping) when one feels uneasy lying still and sometimes has spams that cause jerking in the legs. It is quite disruptive to sleep and EXTREMELY irritating (speaking from experience). Sometimes RLS can be a side-effect of a med (Effexor for me), other times people have RLS when not on meds.
-John
Posted by danf on March 13, 2001, at 6:29:40
In reply to Re: What is restless leg syndrome?-no post » LMM, posted by JohnX on March 13, 2001, at 3:03:55
I developed RLS on effexor as well, along with irritating muscle twitches. Both were persistant for several months. The RLS did not occur the first 6 wks..
this did not happen on celexa or zoloft ( had some twitches during first few weeks, that resolved)
Mg++ supplements 750mg /day stopped both the twitches & RLS.
Posted by JohnX on March 13, 2001, at 7:37:16
In reply to Re: restless leg syndrome and Mg, posted by danf on March 13, 2001, at 6:29:40
> I developed RLS on effexor as well, along with irritating muscle twitches. Both were persistant for several months. The RLS did not occur the first 6 wks..
>
> this did not happen on celexa or zoloft ( had some twitches during first few weeks, that resolved)
>
> Mg++ supplements 750mg /day stopped both the twitches & RLS.Unfortunately I tried Mg supplementation also as I thought it may help resolve my twitches and also my tension headaches. I didn't have much luck, but I'm always looking for natural ways to approach my symptoms.
I'm having another extensive blood work-up done by a new GP physician and one of the things the doctor wanted to check was my magnesium levels, this was without me asking about it and I have a good feeling about this physician. Maybe this testing will give me some interesting feedback.
Surprisingly non of my psychiatrists have done a
lick of testing, they usually just prescribe the meds. Is this a sign of poor psychiatry? I never can get into the doors of the highly recomended psychiatrists.-John
Posted by danf on March 13, 2001, at 10:07:10
In reply to Re: restless leg syndrome and Mg » danf, posted by JohnX on March 13, 2001, at 7:37:16
>
> I'm having another extensive blood work-up done by a new GP physician and one of the things the doctor wanted to check was my magnesium levels, this was without me asking about it and I have a good feeling about this physician. Maybe this testing will give me some interesting feedback.
>
> Surprisingly non of my psychiatrists have done a
> lick of testing, they usually just prescribe the meds. Is this a sign of poor psychiatry? I never can get into the doors of the highly recomended psychiatrists.
>
> -JohnMost psych Drs are not trained in biochem/physiology very well. this is not to take away from their training. muscle physiology & the mechanics of neuromuscular function seem to be of little import compared to psyche function.
Mg++, Ca++ & vit E have impact on the muscles & membranes, themselves as well as central neural effects.
sorry the Mg did not help. Most people do not have abnormal electrolytes unless on a diuretic.
lytes & other lab values do not have much effect ( in general) on psych med function. They do have more effect on side effect profiles. & I don't think, I have ever seeen a psych do labs except for Lithium & lytes when using Li.
Posted by SLS on March 13, 2001, at 16:18:34
In reply to Re: restless leg syndrome and Mg, posted by danf on March 13, 2001, at 10:07:10
> >
> > I'm having another extensive blood work-up done by a new GP physician and one of the things the doctor wanted to check was my magnesium levels, this was without me asking about it and I have a good feeling about this physician. Maybe this testing will give me some interesting feedback.
> >
> > Surprisingly non of my psychiatrists have done a
> > lick of testing, they usually just prescribe the meds. Is this a sign of poor psychiatry? I never can get into the doors of the highly recomended psychiatrists.
> >
> > -John
>
> Most psych Drs are not trained in biochem/physiology very well. this is not to take away from their training. muscle physiology & the mechanics of neuromuscular function seem to be of little import compared to psyche function.
>
> Mg++, Ca++ & vit E have impact on the muscles & membranes, themselves as well as central neural effects.
>I would just like to offer the possibility that taking too much calcium might make depression worse in some people. I believe that the Mg / Ca balance is important
- Scott
Posted by Mr. Scott on March 13, 2001, at 20:00:54
In reply to Re: What is restless leg syndrome?-no post » LMM, posted by JohnX on March 13, 2001, at 3:03:55
Very interesting.. I always seem to develop pain from constantly flexing my muscles while on any SSRI or Wellbutrin.. Does this sound related to RLS to you? I also have fibromyalgia or so they tell me which might explain why the restlessness leads to pain??!!
Posted by JohnX on March 13, 2001, at 23:41:33
In reply to Re: What is restless leg syndrome?-no post, posted by Mr. Scott on March 13, 2001, at 20:00:54
> Very interesting.. I always seem to develop pain from constantly flexing my muscles while on any SSRI or Wellbutrin.. Does this sound related to RLS to you? I also have fibromyalgia or so they tell me which might explain why the restlessness leads to pain??!!
Generally RLS is associated with some sort of hypo-dopaminergic functioning. The medications that can address it are dopamine meds like Mirapex & carbidopa/levodopa , beta-blockers like Inderal (unknown mode of action, probably related to a side effect of the med which acts on serotonin modulating 5ht-1 receptors to inhibit serotonin impulses that inversely modulate dopamine firing), meds with 5ht-2 antagonism like Serzone (where the 5ht-2 antagonism indirectly increases dopamine), and benzodiazepines like Klonopin.
A lot of people taking SRI meds complain about RLS, but I haven't heard of Wellbutrin generally being a suspect (it hardly touches serotonin). Maybe the insomnia it can cause makes you feel restless? RLS can definately be a fybromyalgia symptom as you referred too, although the roots of fybromyalgia seem to be less understood. Dopamine generally counteracts another chemical actylcholine which triggers muscle contractions.
-John
Posted by JohnX on March 13, 2001, at 23:56:29
In reply to Re: restless leg syndrome and Mg, posted by danf on March 13, 2001, at 10:07:10
> Most psych Drs are not trained in biochem/physiology very well. this is not to take away from their training. muscle physiology & the mechanics of neuromuscular function seem to be of little import compared to psyche function.Ha Ha. My 1st psychiatrist got a Phd in Neurology before going into psychiatry. I complained to him about the severe tension headaches and RLS that I was having on/off meds but especially while on Effexor. His response was a sarcastic "well, you could go to an expensive headache clinic". I took his remarks to imply the symptoms were psychosomatic since he claimed to have a thorough understanding of neurology. He prescribed Klonopin as a sleep aid after much bitchin on my behalf. When I told him that it fixed my RLS and tension headaches as well as insomnia, he was quite shocked. I later found out through some indirect quizzing that he knew embarassingly little about the physiology of neurology in general or psychiatry in specific. A neurolist my gp referred me to said that benzos and beta-blockers were good for my symptoms, but he went the beta-blocker root which worked also for me.
I also read about the dopamine root, which AndrewB's Mirapex suggestion falls under.-John
Posted by LMM on March 14, 2001, at 6:32:19
In reply to Re: restless leg syndrome and Mg » danf, posted by JohnX on March 13, 2001, at 23:56:29
> I'm on Wellbutrin SR & Prozac. I started to have muscle twitches all over, mostly in my legs. They are not painful, they are not iritating, just feel weird. Is this RLS?
The twitches did not start until about 8wks into my treatment.
Should I be concerned with this? Do I need to mention this to my doctor? Will it get worse or better, will it stop?
Posted by danf on March 14, 2001, at 7:14:44
In reply to Re: restless leg syndrome/muscle twitches , posted by LMM on March 14, 2001, at 6:32:19
The twitches are different from the RLS. RLS is mediated by nerves, it is kind of like an aberrant reflex. a funny side note is that they are common in dogs on no meds.
back to people.
twitches are common with SSRIs & effexor.Twitches are from increased excitability of muscle fibrils, or from the neuromuscular junction /muscle-nerve receptor area. They are bothersome but not dangerous.
I have never seen any good explination for the myalgias ( & I have those from time to time too, mainly in quadraceps muscles when walking up stairs ). Supposedly this pain is from some minor alteration in muscle or muscle membrane metabolism. myalgias are also common with SSRIs.
serotoninergic meds increase this excitability as does epi & nor-epinephrine .... blood pH changes caused by rapid breathing also affect the muscles, along with serum dissolved Calcium levels.
Posted by willow on March 14, 2001, at 12:57:13
In reply to Re: RLS/muscle twitches/muscle pain , posted by danf on March 14, 2001, at 7:14:44
"a funny side note is that they are common in dogs on no meds."
I was just wondering about this the other evening while watching my dog twitch away in his sleep. Mine start as I start to drift off into a heavy sleep, and I wonder if I look the same as the dog?
"myalgias are also common with SSRIs."
Do you know if this is true for effexor too? I'm finding as the effexor is decreasing the time I require to sleep the muscle pain is increasing. It seems worse since I added domperidone and will ask the doctor about this. I'm going to ask for an alternative.
Willow
Posted by Noa on March 14, 2001, at 13:14:53
In reply to Re: restless leg syndrome/muscle twitches , posted by LMM on March 14, 2001, at 6:32:19
For me, the restless legs is like an "itch"---when lying in bed before falling asleep, I just have this "itch" that compels me to move my legs around. The myoclonus, otoh, is twitching---flexing of muscles completing without volition and I cannot suppress them at all. Even muscles that I would not be able to flex willingly no matter how hard I would try will twich and flex on their own. When I was on Paxil, it was so bad, my arm would shoot straight up in the air, as though being operated by a puppeteer.
These days, I only rarely have the rls or myoclonus, perhaps because of decreased effexor dose and exercise. Plus, I had increased my serzone dose a few months back. On occasion, I will have the restless legs, and klonopin helps.
This is the end of the thread.
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