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Dr. Bob is Robert Hsiung, MD,
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Posted by Zyprexa on July 17, 2007, at 12:59:13
In reply to Restless Legs Syndrome?, posted by jerrypharmstudent on July 17, 2007, at 9:43:14
Other than RLS, what side effects? Sleep ok, anxiety, weight lose, weight gain?
Posted by spriggy on July 17, 2007, at 14:30:27
In reply to Re: Restless Legs Syndrome? » jerrypharmstudent, posted by Zyprexa on July 17, 2007, at 12:59:13
When I went on Ultram for my fibromyalgia/Lymes' pain, I started experiencing Restless Leg Syndrome.
I know Ultran effects seratonin so I suppose that was the reason.
I did a bit of reading and talked to a nutritionist/naturopath who told me that she had seen success with adding an Iron supplement for folks with restless leg syndrome.
Oddly enough, I figured it wouldn't hurt to try and within a few weeks, it did get much better until it went away altogether.
I'm on Zoloft now (3rd week) and I noticed last night that I felt a little bit of that leg restlessness. If I can tuck my legs/feet around a heavy blanket or in the couch cushions (where pressure is applied to them), it seems to help me.
I've also had akathasia which was a MUCH more intense feeling ALL over my body; I felt like I needed to crawl out of my skin or jump out of a window.
Just keep an eye on it and make sure it isn't something more than restless leg.
Hope you find something to help- it sure is annoying and uncomfortable.
Posted by cactus on July 17, 2007, at 19:47:38
In reply to Restless Legs Syndrome?, posted by jerrypharmstudent on July 17, 2007, at 9:43:14
I have restless leg syndrome, and AP's are one of the worst things you can take if you have it. So are antihistamines like benadryl. I take Ropinirole(Requip/Repreve) which has worked wonders for it. There is also mirapex and a few other drugs available for it too. Klonopin works fantastic and so does Valium. BUT, talk to your doctor and see if it really is RLS because you have to rule out TD and akathesia. I have to admit it doesn't sound like akathesia to me. Good luck, it has to be one of the most annoying disorders I have ever suffered from. I think you should seriously consider a sleep study too.
Posted by Phillipa on July 17, 2007, at 20:31:43
In reply to Re: Restless Legs Syndrome? » jerrypharmstudent, posted by cactus on July 17, 2007, at 19:47:38
Jerry many causes read this. Love Phillipa
Preview: Few conditions are characterized by the difficulty encountered in trying to depict their symptoms, but such is the case in restless legs syndrome. Patients report sensations that are not painful yet are distinctly bothersome and can lead to significant physical and emotional disability. Once correctly diagnosed, restless legs syndrome can usually be effectively treated symptomatically, and in some secondary cases, it can even be cured. In this article, the authors focus on clinical features that enable timely identification of the condition and on current management strategies.
--------------------------------------------------------------------------------In the mid-1940s, Swedish neurologist Karl A. Ekbom described a disorder characterized by sensory symptoms and motor disturbance of the limbs, mainly during rest. He named the condition restless legs syndrome (1). Although the syndrome affects about 10% to 15% of the US population (2), it is often unrecognized and misdiagnosed. It may begin at any age (1-3), even as early as infancy, but most patients who are severely affected are middle-aged or older. Symptoms progress over time in about two thirds of patients and may be severe enough to be disabling.
Diagnostic criteria and common features
In 1995, the newly formed International Restless Legs Syndrome Study Group developed criteria for diagnosing restless legs syndrome (3). Four basic elements must be present to make the diagnosis: (1) a desire to move the limbs, often associated with paresthesia or dysesthesia, (2) symptoms exacerbated by rest and relieved by activity, (3) motor restlessness, and (4) nocturnal worsening of symptoms. These and several additional features commonly seen in restless legs syndrome are discussed in the following paragraphs.
Desire to move the limbs, paresthesia, dysesthesia. Patients often describe an unpleasant sensation in the calves and occasionally in the thighs, feet, or upper limbs. Although the study group refers to dysesthesia or paresthesia (which implies abnormal sensations) (3), most patients simply relate vague, nonpainful, indescribable, bilateral (rarely unilateral) discomfort in the limbs, using such terms as crawling, creeping, tingling, burning, itching, and aching.
Symptoms are similar to those described by patients with akathisia (which is usually caused by use of neuroleptic drugs). However, in contrast to patients with restless legs syndrome, those with akathisia have an inner feeling of restlessness, gain the most relief by resting in a recumbent position, and do not experience paresthesia or nocturnal worsening of symptoms.
Symptoms exacerbated by rest, relieved by activity. The unpleasant limb sensations of restless legs syndrome are precipitated by rest or inactivity (eg, lying in bed at night, riding in a car or airplane, sitting in a theater). The discomfort is usually relieved by motor activity (eg, moving the legs, walking).Motor restlessness. Patients describe a buildup of discomfort and involuntary limb jerking if they remain still. There is an urge to move the legs and relief after moving (much like the sensation of tics). Compelling motor restlessness can manifest as tossing and turning in bed, needing to pace the floor, stretching or shaking the legs, or needing to exercise (3). Limb movements in restless legs syndrome are partly voluntary, in that patients choose to move to relieve the discomfort, and partly involuntary, since patients are compelled to move. Such partly voluntary, partly involuntary movements are sometimes referred to as "unvoluntary" or "semivoluntary."
Nocturnal worsening of symptoms. All patients notice worsening of symptoms at night (usually as they lie in bed before sleep or when they are awakened in the middle of the night) and improve-ment early in the morning. Nocturnal worsening is caused by lack of motor activity at night and is also thought to be due to an independent circadian rhythm (3). In severe cases, patients experience symptoms both day and night.
Periodic limb movements of sleep. About 80% of patients with restless legs syndrome have unilateral or bilateral periodic limb movements of sleep, also called nocturnal myoclonus (1,3). These movements are stereotyped, repetitive, slow flexion of the limbs (legs alone or legs more than arms) during stage 1 or 2 sleep. They occur semirhythmically at intervals of 5 to 60 seconds and last about 1.5 to 2.5 seconds. In the lower limbs, repetitive dorsiflexion of the big toe with fanning of the small toes is seen, along with flexion of the ankles, knees, and thighs.
Dyskinesias while awake. These motions, also called periodic limb movements while awake, are seen in 30% to 50% of patients with restless legs syndrome (3). They are similar to periodic limb movements of sleep but occur only during wakefulness. They can be fast or slow and periodic or nonperiodic.
Sleep disturbance. Because of limb discomfort and jerking, most patients with restless legs syndrome have disturbances of sleep onset or maintenance (1,3). The result is excessive daytime sleepiness and fatigability, although not to the same degree as that caused by narcolepsy.
Primary disease
In most cases, restless legs syndrome is idiopathic. Such idiopathic disease can be familial (in 25% to 75% of cases) and, if so, is transmitted in an autosomal-dominant fashion (1,3,4). Progressive decrease in age at onset with subsequent generations (ie, genetic anticipation) has been described in some families. Patients with familial restless legs syndrome tend to have an earlier age at onset and slower progression (5).Secondary disease
Restless legs syndrome can develop as a result of certain conditions or factors (table 1), particularly iron deficiency and peripheral neuropathy (6-12). These two conditions should be ruled out on clinical grounds before restless legs syndrome is labeled primary (13). Because of the prevalence of these conditions in the general population, their association with restless legs syndrome needs to be interpreted with considerable caution.Table 1. Factors and conditions that may contribute to secondary restless legs syndrome (in order of frequency)
Deficiency of iron, folate, or magnesium
Polyneuropathy caused by alcohol abuse, amyloidosis, diabetes mellitus, idiopathic polyneuropathy, lumbosacral radiculopathy, Lyme disease, monoclonal gammopathy of undetermined significance, rheumatoid arthritis, Sjögren's syndrome, uremia, or vitamin B12 deficiencyPregnancy
Anemia
Parkinson's disease
Gastric surgery
Chronic obstructive pulmonary disease
Carcinoma
Chronic venous insufficiency or varicose veins
Intake of certain substances or drugs: alcohol, caffeine, anticonvulsants (eg, methsuximide [Celontin Kapseals], phenytoin [Dilantin]), antidepressants (eg, amitriptyline HCl [Elavil], paroxetine HCl [Paxil]), beta blockers, histamine2 antagonists, lithium, neuroleptics
Withdrawal from vasodilators, sedatives, or imipramine HCl (Tofranil)
Cigarette smoking
Myelopathy or myelitis
Hypothyroidism or hyperthyroidism
Acute intermittent porphyria
Fibromyalgia syndrome
Arborizing telangiectasia of the lower limbs
Peripheral microemboli made of cholesterol
--------------------------------------------------------------------------------
Restless legs syndrome can be the initial manifestation of iron deficiency (1,14). A low serum ferritin level may precede a drop in serum iron level. Depletion of iron stores, in the absence of overt iron deficiency, can lead to restless legs syndrome. How this occurs in unknown. Treatment with ferrous sulfate may bring improvement.About 5% of patients with sensory neuropathy (especially caused by uremia, rheumatoid arthritis, and diabetes) have restless legs syndrome (8). Treatment of the polyneuropathy may improve symptoms.
Diagnosis
Diagnosis of restless legs syndrome is founded mainly on clinical history. If a secondary cause is suspected on the basis of history, abnormal findings on neurologic examination, or poor response to treatment, a laboratory workup should be done. Testing should measure levels of blood urea nitrogen, creatinine, fasting blood glucose, ferritin, magnesium, thyrotropin, and folate and should include a glucose tolerance test and a complete blood cell count.Needle electromyography and nerve-conduction studies should be considered if polyneuropathy is suspected on clinical grounds, even if results of neurologic examination are apparently normal (13). Polysomnography is rarely necessary but may be used to quantify periodic limb movements of sleep or to characterize sleep architecture, especially in patients who continue to have significant sleep disturbance despite relief of sensory symptoms with treatment.
Nonpharmacologic management
Patients with suspected restless legs syndrome who are sensitive to caffeine, alcohol, or nicotine should avoid these substances (1,6). Offending medications (table 1) also should be discontinued. In general, physical measures are only partially or temporarily helpful. Some patients benefit from hot or cold baths, whirlpool baths, rubbing of the limbs, or vibratory or electrical stimulation of the feet and toes before bedtime.Supplementation to correct deficiencies in vitamins (eg, folate) (15), electrolytes (eg, magnesium) (7), or iron may improve symptoms. Patients with prominent varicose veins in the legs may benefit from use of sclerosing agents (9). Those with uremia may have relief after kidney transplantation or correction of anemia with erythropoietin (Epogen, Procrit) (6).
Pharmacologic management
Drug therapy for primary restless legs syndrome is largely symptomatic, since cure is only possible in secondary disease. Medications should be initiated at a low dose and be taken an hour or two before bedtime to allow sufficient absorption and onset of action. Additional doses can be taken if symptoms cause awakening in the middle of the night. If tolerance to one drug develops, another class of drugs may be substituted. Monthly rotation of two or three agents found to be effective may help prevent tolerance. A combination of drugs may be beneficial in severe cases.Levodopa with carbidopa Levodopa with carbidopa (Sinemet) can improve sensory symptoms and periodic limb movements of sleep in primary restless legs syndrome and that associated with uremia (1-3,16). For symptoms that start before sleep, one 25/100-mg carbidopa/levodopa tablet can be taken 1 to 2 hours before bedtime. If symptoms occur during the night, one 25/100-mg controlled-release carbidopa/levodopa (Sinemet CR) tablet can be used. In patients who have symptoms both before sleep and during the night, a combination of short-acting and controlled-release tablets can be given. Most patients experience benefits when the levodopa portion of carbidopa/levodopa totals 100 to 500 mg daily, although some may need 1,000 to 1,500 mg. Nausea and constipation are the most common side effects of levodopa.
The major drawback in prescribing levodopa for restless legs syndrome is that in about 80% of patients, augmentation of symptoms occurs as early as a few months after initiation of therapy (17). It can manifest as earlier onset during the evening or after assuming a restful position, as increased intensity in the morning (ie, rebound), or as extension of symptoms to the upper body. Augmentation is more likely in patients with severe pretreatment symptoms and in those taking 200 mg or more of levodopa daily. If augmentation or rebound develops, adjunctive therapy with reduction of the levodopa dose or discontinuation of levodopa and substitution of another drug may help.
Dopamine agonists Dopamine agonists are less likely to produce augmentation or rebound and can be useful alone or along with levodopa in patients in whom one of these conditions develops (2,17,18). Side effects of dopamine agonists include nausea, light-headedness, drowsiness, and postural hypotension.
Pergolide mesylate (Permax) is a potent, long-acting dopamine D1 and D2 receptor agonist that has been shown to be effective in restless legs syndrome (1-3,16), even in patients who are unresponsive to levodopa (18). The dose is 0.05 mg before bedtime initially, and it can be increased by 0.05 mg every 3 to 5 days until relief is obtained or side effects develop. The usual effective daily total is 0.1 to 0.75 mg, given in divided doses; some patients may need up to 1.5 mg.
Bromocriptine mesylate (Parlodel), a dopamine D2 receptor agonist, also has been found to be effective in restless legs syndrome (1-3,18). Bromocriptine can be started at a dose of 1.25 mg at bedtime and increased by 1.25 mg every few days until benefits or side effects are noted. The effective daily dose ranges from 5 to 15 mg.
Pramipexole (Mirapex), a dopamine D2 and D3 receptor agonist, and ropinirole hydrochloride (Requip), a dopamine D2 receptor agonist, were recently approved by the Food and Drug Administration for treating Parkinson's disease. Pramipexole is started at 0.125 mg at bedtime and gradually increased to a maximum of 1.5 mg three times daily. Ropinirole is started at 0.25 mg and increased to 3 to 8 mg three times daily (19,20).
Benzodiazepines Benzodiazepines may be used as monotherapy in patients with mild or intermittent symptoms or as add-on therapy in severe cases. Clonazepam (Klonopin) has been shown to ease the sensory symptoms and periodic limb movements of sleep in restless legs syndrome (1-3,16). The agent can be started at 0.25 mg at bedtime and increased by 0.25 mg every week to a maximum of 3 to 4 mg daily in divided doses. Anecdotal reports indicate that other benzodiazepines, such as temazepam (Restoril) and alprazolam (Xanax), are also effective. The major side effects of benzodiazepines include daytime drowsiness and confusion, unsteadiness and falls, and aggravation of sleep apnea.
Opioids Low-potency opioids, such as codeine and propoxyphene (Darvon, Dolene), can benefit patients with mild and intermittent symptoms, and higher-potency agents, such as oxycodone hydrochloride (Roxicodone), methadone (Dolophine) hydrochloride, and levorphanol tartrate (Levo-Dromoran), may have a role in refractory cases (1-3,16). In a double-blind, placebo-controlled study, oxycodone (mean daily dose, 15.9 mg) was found to be more effective than placebo (21). However, most physicians are hesitant to use opioids in restless legs syndrome because of the perceived risk of addiction and do so only in refractory cases.
Anticonvulsants Double-blind studies have shown that carbamazepine (Tegretol), at a dose of 200 to 400 mg daily, is effective in reducing sensory manifestations of restless legs syndrome (1-3,16), especially among young patients with recent onset of disease and severe symptoms. Unfortunately, subsequent clinical experience has not shown convincing efficacy of carbamazepine.
Open-label studies have found gabapentin (Neurontin) to be effective in relieving sensory symptoms (22) and periodic limb movements of sleep, even in refractory cases. The drug can be initiated at a dose of 100 to 300 mg at bedtime and increased by 100 to 300 mg every 3 days to a maximum of 2,400 mg daily in divided doses. Gabapentin is usually well tolerated but may cause transient or mild side effects, such as somnolence, dizziness, ataxia, and fatigue.
Presynaptic alpha2-adrenergic agonist Clonidine hydrochloride (Catapres) may be effective in primary restless legs syndrome and that associated with uremia (1-3,16). The drug should be started at 0.1 mg at bedtime and can be increased every week by 0.1 mg to a maximum of 1 mg daily (average effective daily dose, 0.5 mg). Among the common side effects are dry mouth, decreased cognition, light-headedness, sleepiness, and constipation.
Summary
Restless legs syndrome is a common, potentially disabling condition that affects about 10% to 15% of the general population and yet is often unrecognized and misdiagnosed. It is mainly diagnosed clinically and only rarely requires polysomnography. The condition is usually primary and treatable. First, however, secondary causes should be sought, especially iron deficiency and peripheral neuropathy, because when the source is an accompanying factor or condition, the syndrome may be curable. The most effective drugs are dopaminergic agents, clonazepam, opioids, gabapentin, and clonidine. Additional agents are available that may be beneficial as add-on or alternative therapy.References
Trenkwalder C, Walters AS, Hening W. Periodic limb movements and restless legs syndrome. Neurol Clin 1996;14(3):629-50
Silber MH. Restless legs syndrome. Mayo Clin Proc 1997;72(3):261-4
Walters AS, for the International Restless Legs Syndrome Study Group. Toward a better definition of the restless legs syndrome. Mov Disord 1995;10(5):634-42
Trenkwalder C, Seidel VC, Gasser T, et al. Clinical symptoms and possible anticipation in a large kindred of familial restless legs syndrome. Mov Disord 1996;11(4):389-94
Ondo W, Jankovic J. Restless legs syndrome: clinicoetiologic correlates. Neurology 1996;47(6):1435-41
O'Keeffe ST. Restless legs syndrome: a review. Arch Intern Med 1996;156(3):243-8
Popoviciu L, Asgian B, Delast-Popoviciu D, et al. Clinical, EEG, electromyographic and polysomnographic studies in restless legs syndrome caused by magnesium deficiency. Rom J Neurol Psychiatry 1993;31(1):55-61
Rutkove SB, Matheson JK, Logigian EL. Restless legs syndrome in patients with polyneuropathy. Muscle Nerve 1996;19(5):670-2
Kanter AH. The effect of sclerotherapy on restless legs syndrome. Dermatol Surg 1995;21(4):328-32
Sanz-Fuentenebro FJ, Huidobro A, Tejadas-Rivas A, et al. Restless legs syndrome and paroxetine. Acta Psychiatr Scand 1996;94(6):482-4
Drake ME. Restless legs with anti-epileptic drug therapy. Clin Neurol Neurosurg 1988;90(2):151-4
Metcalfe RA, MacDermott N, Chalmers RJ. Restless red legs: an association of the restless legs syndrome with arborizing telangiectasia of the lower limbs. J Neurol Neurosurg Psychiatry 1986;49(7):820-3
Iannaccone S, Zucconi M, Marchettini P, et al. Evidence of peripheral axonal neuropathy in primary restless legs syndrome. Mov Disord 1995;10(1):2-9
O'Keeffe ST, Gavin K, Lavan JN. Iron status and restless legs syndrome in the elderly. Age Ageing 1994;23(3):200-3
Botez MI, Lambert B. Folate deficiency and restless-legs syndrome in pregnancy. N Engl J Med 1977;297(12):670
Krueger BR. Restless legs syndrome and periodic movements of sleep. Mayo Clin Proc 1990;65(7):999-1006
Allen RP, Earley CJ. Augmentation of the restless legs syndrome with carbidopa/levodopa. Sleep 1996;19(3):205-13
Earley CJ, Allen RP. Pergolide and carbidopa/levodopa treatment of the restless legs syndrome and periodic leg movements in sleep in a consecutive series of patients. Sleep 1996;19(10):801-10
Ondo W. Ropinirole for restless legs syndrome. Mov Disord 1999;14(1):138-40
Lin SC, Kaplan J, Burger CD, et al. Effect of pramipexole in treatment of resistant restless legs syndrome. Mayo Clin Proc 1998;73(6):497-500
Walters AS, Wagner ML, Hening WA, et al. Successful treatment of the idiopathic restless legs syndrome in a randomized double-blind trial of oxycodone versus placebo. Sleep 1993;16(4):327-32
Adler CH. Treatment of restless legs syndrome with gabapentin. Clin Neuropharmacol 1997;20(2):148-51
--------------------------------------------------------------------------------What are the mechanisms that cause restless legs syndrome?
Pathogenesis of the syndrome is unclear. Karl A. Ekbom originally proposed that it was mainly the result of accumulation of metabolites in the legs from venous congestion (1-3). Peripheral nerve abnormalities have also been proposed, but no structural changes in nerve endings have been seen (4). Many experts believe that the syndrome is generated centrally (1,3,5). Periodic limb movements of sleep, in particular, are thought to be caused by sleep-related disruption of descending inhibitory reticulospinal pathways that are normally active at the brain stem or spinal cord level.On the basis of treatment response, restless legs syndrome has been linked to dopaminergic or opiate abnormalities (3). Dopamine blockers and opiate blockers reactivate symptoms when given to patients with the syndrome. Results of single-photon emission computed tomography have suggested deficiency of dopamine D2 receptors (6). Sympathetic hyperactivity has also been implicated (5) on the basis of observations that sympathetic nerve blockade relieves periodic limb movements of sleep and that alpha-adrenergic blockers improve symptoms of restless legs syndrome. Studies also have suggested possible underactivity of the serotonin and gamma-aminobutyric acid neurotransmitter systems
Posted by AnneMargrock on July 17, 2007, at 21:00:01
In reply to Restless Legs Syndrome?, posted by jerrypharmstudent on July 17, 2007, at 9:43:14
Have you tried regular old asprin? I had read about it helping with RLS so I tried it. It works great. I take two reg strength tabs. Asprin(acetylsylic acid) is a blood thinner and anti-inflammatory so this may be why it works, but it definitely has helped me on the odd night I can't sleep because of RLS. Just make sure it is not contraintidicated for the meds you are on. Good luck.
Posted by Mistermindmasta on July 17, 2007, at 22:43:17
In reply to yep.. I've had Restless leg syndrome, posted by spriggy on July 17, 2007, at 14:30:27
> Oddly enough, I figured it wouldn't hurt to try and within a few weeks, it did get much better until it went away altogether.
It's amazing that you say that and it gives me hope that some of my problems may be fixable through iron supps. I've been reading a lot about how low ferritin (from low iron stores) can cause symptoms of ADHD and RLS. Interestingly, one can have perfectly normal hemoglobin, which is the traditional iron level indicator, but very low ferritin. Ferritin appears to be involved in dopamine function, so it makes sense that iron supps could benefit people with low ferritin - adhd and rls people.
I have a few questions. First, how many mg / day of iron did you take? How long were you taking it? Did you experience continuous full relief even after discontinuation of the iron? Any side effects from iron supplementation?
I'm taking 80 mg of iron every other day. I have no documented low ferritin (never had the blood test), but i figure taking iron for 5 months isn't going to kill me unless i have that hemochromatosis or whatever where i store excess iron. Hopefully I don't have that.
I've been taking 10 mg of selegiline / day along with about 2 grams of kratom and a host of other supps. Kratom is an legal herbal opioid (yes, really) and I'm thinking that once the selegiline and kratom wear off, that my rls-ish symptoms are exacerbated. So for the opiate users, in my experience, they can cause rls once they wear off.PS, for those who haven't tried kratom and are looking for a real herb that actually WORKS, this is it. This stuff is for real. Totally legal, totally opiate. 7-hydroxymitragynine is the recently identied active compound - 20 times stronger mu opioid receptor agonist compared to morphine. But try not to abuse it cuz then the gov't will catch on and it will be illegal. The feds like to make anything illegal that actually works and doesn't have harsh immediate side effects. Thus the reason why people ABUSE it in the first place! Cuz it works! The only problem with kratom is that 12 grams of some good 15x stuff is like $40. And it takes a gram or two to feel good, so it basically costs like $3 - 4 per serving of legal opiate high. Which, for right now, is ok with me. Way cleaner than alcohol if you wanna do a recreational drug.
Posted by jerrypharmstudent on July 18, 2007, at 0:36:23
In reply to Re: Restless Legs Syndrome? » jerrypharmstudent, posted by Zyprexa on July 17, 2007, at 12:59:13
> Other than RLS, what side effects? Sleep ok, anxiety, weight lose, weight gain?
Sleep is great (with addition of Lunesta instead of Ambien), no weight gain - some weight LOSS. Feel more emotionally stable.
BUt with sleep I have to shift positions alot and move my legs almost constantly before I finally fall asleep. This only seems to get worse when I increase the abilify from 2.5 to 5mg.
Also, if I wake up early my legs go crazy again and it's almost impossible to get back to sleep.
Posted by jerrypharmstudent on July 18, 2007, at 0:40:06
In reply to Sorry for confusion w above post, Dx of Akathesia, posted by stargazer2 on July 17, 2007, at 12:11:25
> Jerry, upon further review the symptoms you are experiencing sound more like akathesia, a restless feeling where you can't sit still. Also, a side effect of AP's like Abilify.
>
> Followup with your pdoc to decide what to do, perhaps a lowering of your AP dose. What besides abilify are you on? Any second AP?
>
> Stargazer2Yeah I thought about Akathasia. Problems is Klonopin doesn't seem to help nor does an antihistamine. Like I was saying in another post - it only seems to happen when I move my Abilify up from 2.5 - 5mg. Well - it gets much less tolerable I should say.
I'm not on any other AP - just Lexapro, Lunesta, Adderall, Hydrocodone and Klonopin. Weird thing is - is that if I take a little bit of Adderall in the middle of the night when my legs are really bad it seems to help clam them down which leads me to believe that dopamine is involved. Also, the Hydrocodone helps a bit too.
Stumped.....
Posted by jerrypharmstudent on July 18, 2007, at 0:42:20
In reply to yep.. I've had Restless leg syndrome, posted by spriggy on July 17, 2007, at 14:30:27
> When I went on Ultram for my fibromyalgia/Lymes' pain, I started experiencing Restless Leg Syndrome.
>
> I know Ultran effects seratonin so I suppose that was the reason.
>
> I did a bit of reading and talked to a nutritionist/naturopath who told me that she had seen success with adding an Iron supplement for folks with restless leg syndrome.
>
> Oddly enough, I figured it wouldn't hurt to try and within a few weeks, it did get much better until it went away altogether.
>
> I'm on Zoloft now (3rd week) and I noticed last night that I felt a little bit of that leg restlessness. If I can tuck my legs/feet around a heavy blanket or in the couch cushions (where pressure is applied to them), it seems to help me.
>
> I've also had akathasia which was a MUCH more intense feeling ALL over my body; I felt like I needed to crawl out of my skin or jump out of a window.
>
> Just keep an eye on it and make sure it isn't something more than restless leg.
>
> Hope you find something to help- it sure is annoying and uncomfortable.yeah I'm kinda stumped. it's mostly in my legs - but I'm also feeling it in my arms too. But - for example - today I had to drive 2 hours and it was hellish - I couldn't get comfortable. And the other night when I went to a movie I couldn't get my legs in a comfortable position.
So I'm not entirely sure but it does feel like my legs are VERY restless.
Posted by jerrypharmstudent on July 18, 2007, at 0:45:09
In reply to Re: Restless Legs Syndrome? » jerrypharmstudent, posted by cactus on July 17, 2007, at 19:47:38
> I have restless leg syndrome, and AP's are one of the worst things you can take if you have it. So are antihistamines like benadryl. I take Ropinirole(Requip/Repreve) which has worked wonders for it. There is also mirapex and a few other drugs available for it too. Klonopin works fantastic and so does Valium. BUT, talk to your doctor and see if it really is RLS because you have to rule out TD and akathesia. I have to admit it doesn't sound like akathesia to me. Good luck, it has to be one of the most annoying disorders I have ever suffered from. I think you should seriously consider a sleep study too.
Thanks for your post. I have had a sleep study which didn't show any signs of RLS - but I HAVE been treated for bouts of RLS before with Mirapex which really didn't help. I've found that Benzos usually help best with akathasia but not so much with RLS.
I called my doc to ask him what he thought. but whether it be RLS or Akathasia it's MOST uncomfortable. I just don't want tot go off the Abilify because it's helping me so much.
Posted by cactus on July 18, 2007, at 18:55:34
In reply to Re: Restless Legs Syndrome? » cactus, posted by jerrypharmstudent on July 18, 2007, at 0:45:09
Wow jerry you've really stumped me now, maybe I'll take back my statement about akathesia because Hydrocodone and opiates in general, are the last line of treatment for RLS. And if you're taking Hydrocodone and Klonopin together, that just makes me wonder that it's got to be related to the abilify, as you have said. The only other thing I can think of is anti convulsant/mood stabliser such as carbamazepine and gabapentin. Good luck, I hate funky leg action, it drives me banana's
Posted by Zyprexa on July 19, 2007, at 18:56:30
In reply to Re: Restless Legs Syndrome? » Zyprexa, posted by jerrypharmstudent on July 18, 2007, at 0:36:23
> > Other than RLS, what side effects? Sleep ok, anxiety, weight lose, weight gain?
>
> Sleep is great (with addition of !Lunesta!(tiny more?) instead of Ambien), no weight gain - some weight LOSS. Feel more emotionally stable.!
>
> BUt with sleep I have to shift positions alot and move my legs almost constantly before I finally fall asleep. This only seems to get worse when I increase the abilify from 2.5 to 5mg.
>I wouldn't take anymore than you have to. Even if it means taking an extra dose once every 3rd day or so. 2.5!
> Also, if I wake up early my legs go crazy again and it's almost impossible to get back to sleep.
>
>
>
Posted by OzLand on July 19, 2007, at 22:48:40
In reply to Restless Legs Syndrome?, posted by jerrypharmstudent on July 17, 2007, at 9:43:14
My husband has RLS; he used to take Klonipin (sp?), but he had to keep increasing the dose. Then he switched to one of the Parkinson's Disease drugs and became psychotic on it and had to quit. Sinemet, I think. Same thing happened to my father on that drug when he had Parkinson's. Now he takes nothing, my husband, but we can't sleep in the same bed as he could end up kicking me really hard in the night. It has happened before. Even now, he kicked so hard one time he broke a window in our guest bedroom. I think it is actually better now that he is older, or maybe it is just all his other meds, and some help by accident. He is on heart medications, cholesteral medications, Prozac, and vitamins and fish oil and baby aspirin. I think that is it.
Posted by cactus on July 20, 2007, at 1:26:23
In reply to Re: Restless Legs Syndrome? » cactus, posted by jerrypharmstudent on July 18, 2007, at 0:45:09
jerry have you checked out rls.org? I found some great info there when I was diagnosed. Maybe they might have some answers for you? The forums are quite good and very supportive.
Posted by smpayne69 on July 20, 2007, at 14:32:58
In reply to Re: Restless Legs Syndrome? » jerrypharmstudent, posted by cactus on July 20, 2007, at 1:26:23
Greetings all!
I had been fighting with RLS for years, and have seen specialists from all fields, read countless books in physiology and neurobiology; Most recently "Mind Wide Open" by Stephen Johnson and "The Universe in a Single Atom" by the extremely wise Dali Lama.
Like a lot of you, I got to an expatriated point in my life. The RLS started not only bothering me at night, but began affecting me throughout the day. Thereby, really effecting my work performance. So, I decided to put a lot of study into the subject, which was in itself difficult due to my RSL issue. Upon reading texts and listening to seminars, I began to have doubts about some of the theories surrounding RLS. One of the earlier theories was, of course, a psycological illness and could be treated by meditating or preoccupation. I then learned to art of meditation. I must admit, it did help once I was able to train myself to focus on nothingness, but the RLS knew I was not meditating at work or sleep, so returned. At that point I, through meditation, proved to myself that it was not a psycological condition. I then decided to try acupuncture, which directly interacts with nerves and nerve endings. Coordinating with a specialist, I went to a late evening session. I have always been sceptical of this type of medical process, but was open minded (a very good state to be in when testing a theory). About 1 minute into the process, the RLS was completely gone! He had isolated major nerve centers....so OK, it IS physical. The nerves were still in an uproad, however, the signal of that argument was not reaching my concious mind.
Now after all my research, I found that Dopamine is a major player in regulating nerve behavior and the human 'reward or pleasure' centers. Opiates are created naturally by the brain to reward you when you have done something worth the reward...like maybe winning Manager of the Year. This reward system is boosted dramatically by artificial doses of Opiates, such as that found in Heroin, Vicotin, Codein, Lortab, etc...
I was now at a very comfortable point in understanding what may be going on. This next step, I suggest you just take my word for and do not attempt yourself.
In order to validate to myself what was actually going on in my crazed serotonin/dopamine world, I decided to fake a severe back strain to go on Lortab for 8 weeks. When I started on the Lortab, I felt my pleasure centers firing up and giving me a central whole feeling of well being. On day 2, my RLS disappeared completely! So, 7 and a half weeks of great sleep and a general feeling of well being would be about to come crashing down around me. You see, the second part of using myself as a lab rat was about to kick in...withdrawal. Now, I had never experienced withdrawal before, but understood the symptoms. About 12 hours after I seized taking the Lortab, I started to feel the symptoms. Shaking, sweating, tightness of muscles, complete lack of concentration, and you guessed, the worst RLS I have ever had in my left. I was ready to shoot myself in the head about 4 days into it. But, logic prevailed and I was happy to know that I believe I had targeting the RLS culprit...dopamine!
As most probably read, another theory is Iron deficiency. I take a regular quality multivitamin from GNC and have a healthy lifestyle. I believe if it were Iron deficiency and so much that it caused nerve chaos in my legs (whole body during withdrawal) then I would see some basic Iron deficiency symptoms as well, like sores in the mouth, thinning nails, etc... But I had absolutly no Iron deficiency and was proved by a complete blood panel.
So, what was my next step you ask. Well, to prove my own theory, I needed a type of Dopamine booster. I feel there are a lot of people out there that have this deficiency through natural genetics and/or environmental elements while growing through childhood where the chemical formations are at its purist development.
The next part, and most recent, is quite funny. First of all, one of the doctors I went to a year ago placed me on Zoloft because I was having mood swings. I have been on that for a year, and have no mood swings at all since. I do believe that my serotonin levels are lower that normal and inhibiting the uptake as helped build up a healthy supply. However, to my studies and testing, the serotonin has no relation to RLS. So, it is a year of being on the Zoloft meds and I return to the doctor and a wealth of knowledge and true life self inflicted experience. The office had me complete a series of tests which were basically focused on Mood Disorder, Attention Deficit, and Depression. It was discovered that I was very ADD! Which, solidified my theory of low dopamin levels as a whole. I indicated to the doctor that I believe I had low dopamine levels and also believe I had high Zeta levels (Brain waves that controlled concentration and attention measured on a scale of 1 to 5). I explained that my own theory is, for some reason, my nerves are attempting to do something systemically, but unable to complete the communication to the very basic animal brain functions located in our brain stems, so is manifested at the origin...which simply seems to start in the lower body area. For those with severe RLS, or withdrawing from Opiate addiction, it will start in the legs, but will spread slowly upward to arms and hands.
With a dopamine boost, or blocker per say, those levels build up in your system and ultimately feed your body properly. I have since been put on Adderall XR and the RLS symptoms have pretty much disappeared. Every now and then I feel it a tiny bit, but I believe over time that with subside as well. I sleep extremely well, I have turned my professional life completely around, and living a much more fulfilling life.
The Revered Dali Lama makes mention to the simple fact that we are all animals to an extent. I believe that, and further more, I theorize that we are animals living in an age not designed for animals. As animals we pick and eat what we want, which many plants have these boosts of dopamine as a basic ingredient. I plan on doing my own study as to the differential of RLS between vegetarians and carnivores...it would be interesting to see the results.
Please take this 'book' with a grain of salt because my medical history and yours will be different. And please, DO NOT do the opiate test...I did it for all of us and the withdrawal process was the worst experience of my life. Just take the results as informational thought and speak to your doctor before trying anything. For myself, I truly believe I had a dopamine deficiency that both hindered my focus and concentration for years, and provided me with those countless sleepless nights.
I hope my research helps at least one of you to overcome your illness and please email me if you have any questions.
Sincerely,
SMPayne.
Posted by cactus on July 20, 2007, at 19:05:31
In reply to How I beat RLS and discovered ADD., posted by smpayne69 on July 20, 2007, at 14:32:58
Thankyou so much, that was a very inspiring story for me. Mainly due to the fact that I have the concentration of a gold fish and crappy RLS and PLMD. The dopamine agonist ropinirole has help with the RLS but has only improved my attention span slightly, I started zoloft 4 weeks ago and it's gone backwards again. I see my pdoc next week. I hope he can do a full ADD test.
Posted by smpayne69 on July 20, 2007, at 21:41:52
In reply to Re: How I beat RLS and discovered ADD. » smpayne69, posted by cactus on July 20, 2007, at 19:05:31
I hope things work out for you. From my own research, 25 to 30mg of Adderall XR appears to have the most impact on enabling my attention and completely stopping the RLS. Of course, you may have to play lab rat with a few different meds over a longer period of time to find what works, but keep with it and don't give up! Make sure the meds you take have the desired dopamine controller. 30mg is the highest dosage, and I am on 25mg and feeling great.
I truly believe we are continuing to evolve and our generation is really feeling the impact of learning to deal with lower major chemicals, including dopamine that were maintained by our ancestors with the type of lives they lived. If a small chemical adjustment can help us live a happy and success life, then all the science and research has done its job.
SMPayne.
Posted by jerrypharmstudent on July 22, 2007, at 8:50:05
In reply to How I beat RLS and discovered ADD., posted by smpayne69 on July 20, 2007, at 14:32:58
interesting information. My problems is that I'm on hydrocodone and Adderall and I'm still having symptoms.
Jerry :-/
Posted by smpayne69 on July 22, 2007, at 16:04:38
In reply to Re: How I beat RLS and discovered ADD. » smpayne69, posted by jerrypharmstudent on July 22, 2007, at 8:50:05
Hi Jerry,
Yeah, I don't believe you are going to see the benefits of the controlled dopamine when you are adding a load of Opiates to the mix. In some manner, you may be 'breaking even' as if you were not on either drug at all, just now simply physically addicted.
Question: Are you taking the Hydro because of the sense of well being and pleasure? I can certainly understand if you are...I thought about that when I was on it, but quickly changed my mind after a crash refresher biochem course. I new the hunger would never stop and the balance would never be met. If you are taking it as part of a pain management therapy, you may have to stay on it, or put major time into seeking a non Opiate pain reliever. Many people start taking Opiates and stay on it long after the pain has gone because of the effects and addiction.
In my own opinion, and my personal experience with hydrocodone (Lortab), I went from 6 tablets a day as prescribed, right up to 12 a day because my body WAS becoming accustomed to the increase in Opiates. Add that to my tendency for addiction due to my chemical makeup, it was a train wreck waiting to happen. You may not have increased the Hydro intake as quickly as I did due to the fact you are also on Adderall, because if many theories are remotely correct, the increase in your Dopamine control process allowed for the extended desire feelings. Of course, that is just pure theory and you may have reacted completely different, so take it with the grain of salt that it is.So, my suggestion is talk to your doctor. You are going to most probably feel the effects of 2 different withdrawals, but by maintaining communication with your doc, the misery can be lessened.
I believe you are going to have to put some time into this, such as I did. You are most likely at the 'I am so sick of being this way' stage, which I understand to be the first step toward clarity.
I think coming off the Hydro is the definite first step. If you can, and do not require it for pain (or can use an alternate solution) have your Doctor manage you off very slowly. Now, there is kind of a trick that I have picked up from Mind studies and lectures and decided to try them after my initial attempt to withdrawal was unsuccessful; instead of coming off, I seemed to be only able to just manage on the current dose and spread the times out a little. With the known facts that, at the very basic level, animals learn and remember most from the act of surprise; as do humans. So, you need to trick your mind into believing that less of the hydro is the same as more. Let me explain; you have to 'manually' operate the reward center in your brain. So set up a rough schedule of withdrawal timeline. Do not drop the entire schedule to quickly, but initially try to stop taking it for 2 days. MAKE SURE you speak to your Doctor prior to doing this, as it does increase system stress, and we all have completely different tolerances. My 2 days, could be 1 day or 4 days for you...just try to keep the principle idea in mind.
So I decided to spend the weekend hunkered down at home with a loved one. My wife was my guiding hand in this process when I finally figured out how to properly withdrawal. Now, keep in mind I was ingesting 6000mg(12 X 500mg tabs) per day! I was actually at a point where I started observing disruptions in the motor skills area. So, on the evening of the 2nd day I was in a pretty bad way. I felt like my body was going to compress and explode at the same time. But I knew that if I could not handle any more, my wife would provide the next dose that my body was craving; and only under the guidelines we set prior to starting this. Knowing this severely reduces the anxiety that comes as part of the withdrawal process and can manifest differently in everyone. I had planned to back down to 10 a day starting on Monday, a goal that I thought I could easily attain. Setting unrealistic goals will react negatively and will actually act against the natural reward system. So, it was approaching the 40 hr mark and I decided that I put my body through enough stress for the initial 'mental shocking' process.
Now something very curious happened to me mentally and physically. My mind went from wanting the Opiate for the addiction of how it made me feel, to that of instinctive survival. Hence, why some addicts kill, steel, and lie to get one fix...basic survival instinct. Well, I started talking to my wife while shaking and sweating and trying to focus. Her having more psychology study from her time in university, and me not being very mentally aware at the time, I asked her if something else may be taking dominance in my mind. I was really at a point where I did not care about obtaining pleasure, I just wanted to release the pain.This was a CRITICAL point in my withdrawal process. Simply put, survival is stronger than pleasure, when not considering someone with manic depression and really don't feel like even obtaining please, and has a difficult time wanting to even survive. I knew my feelings of depression were simply the lack of pleasure sensors firing. So, I focused on my instinctive survival impulses. You can really logically feel these instincts coming to surface, so be careful to ensure to keep a handle on emotions such as aggression. I'm lucky my wife didn't leave me the amount of times I snapped at her during this process.
So, I decided to have my wife call my employer and tell him I was really sick and would most likely not be in the next day; nowhere near a lie! I WANTED to fight with this inner enemy, demon...whatever you believe to call it. We all know that it's called something different by all societies, but is very much the same. I did not fight too long, maybe a couple hours, but that really helped. My mind was ready to accept the hydro to help the pain, not get the desire. And, I managed to fight a couple extra hours past my goal.
It was about midnight or so and my wife gave me 2 Hydro (Down from the 3 I normally took). It was about the regular 45 minute reaction time before I started feeling my muscles relaxing, my mind clearing, and breathing coming back to normal. As indicated in my previous post about the steps of study I performed, RLS really hit hard with the withdrawal as well...giving proof to my own issue with dopamine related RLS. The dopamine during a withdrawal may be in a state of flux with all kinds of nerve related wonders happening. About 2 hours into it, I was totally relaxed and DANGER!! I felt the pleasure a little like I did the first time I started. DO NOT focus on the pleasure, FOCUS on the relief of the withdrawal! Play the misery in your mind, and how it has been relieved. The 'Mind' is a powerful player here.
For me, came a surprise. I woke up the next morning with not so much of that morning disoriented craving. It was there but much further back in my mind. I believe the initial stage of starving my system and then feeding it a lesser amount completely and subconsciencly tricked my mind into thinking it was MORE than normal. I continued to focus on the misery relief the drug had given me, with only 2/3rds the dosage. Be strong mentally here! Don't take anymore until you physically feel you need it. But, don't punish yourself like you did with the initial 2 day gap...your mind knows its being trained even if you don't. Just like the shock collar (PETA Approved) we used on our extremely bad beagle, Gracie. When the door opened and she saw a break, instinctively she needed to run and track a scent. Being a part of the hound family and her being a full breed, her indicatives heritage is extremely strong. So, upon chasing the dog for miles, I would scold her for actually doing what was totally natural, necessary, and really out of her control. So enter the collar. Both my wife and I were extremely apprehensive about using this tool to train. So, what would anyone do?? Get the brother-in-law to test it on himself. He put it on the medium setting and held it to his breast bone...similar to where the dog would feel it. He would not allow me to operate the controller of course, so I sadly surrendered any thoughts of pure pleasure of brotherly torture. In any case, he pressed the button and jumped about 5 feet! My first thought was of horror (to be honest, the horror was mild...most emotions we pretty dead during the last stages of the Opiate experiment). However, my wife had no problem thinking of what would happen to our little doggy. However, the in-law stated that it was just a deep vibration that surprised him, not electrified him. He had no repeating the process So, we put the collar on the dog and picked a command word; We use STOP. With faith, we opened the door and watched the tail end of our pup tear out only to slow down a little when she heard the high pitch tone of her collar (The collar is equipped with a high pitched tone that the dog will always connect to the memory of initial shock, or surprise). However, she continued on only to be met with a ground departing surprise and a yelp. Then I command 'STOP!' very firmly. She came back into the house with her tail between her legs. That was the only time we used the shock feature, and she never runs from from us. If her mind gets a little overwhelmed by instinct, a tone will immediately bring the memory of shock back which relates to STOP. Now all we do is say STOP. This was also accomplished in 2 days. Now that we controlled the natural instinct, Gracie is able to really use her instinctive senses because we can take her out to a large park and let her go, confidently knowing that we can snap her out of it at any time. During this whole process, her reward system is active in her and she gets the pleasure from her instinctive need to hunt. I throw medium heavy bones deep into a local wooded area and she hunts and retrieves. Now, when at home, she is a completely different dog. Much better behavior, now stressful chewing, etc. Her brain is now chemically balanced with the help of an external tool. Of course, people would argue that we did not need the collar, just let her go be a free hunting dog...but the is not our current reality is it? The dog would always be in danger of the elements of nature, would not gain much more benefit. To quote the Dog Whisperer, "Dogs want to work.". That's why that species are such loyal companions...they get the greatest pleasure release from pleasing a loving owner.
So, back to my point. As the Dogs instinctive motivation for survival out ways it's desire, the desire is controlled. In our case, when withdrawing, we have to hit that wall where survival out ways the need for pleasure. To take my little Gracie as an example, if I started one day complete abusing her, she would most likely keep coming to me because of instinctive addiction until she hit the wall and survival instinct took over and I found myself half eating and left for the local squirrels.
That Monday morning, I was contemplating how I REALLY truly felt. I knew that I felt a lot better than the night before, but could easily feel the need for that desire fix again on the edge of my mind. So, what was this physically?? My RLS was again subsided due to the dopamine regulation (Understand that the cause of RLS is still not completely known...I have simply discovered that the control of Dopamine took care of mine; whether it was directly or indirectly the dopamine is something that is still unknown to me. My own belief is that the balance between triggers and receptors play a very major role). So, I theorized that the greater the gap in the syncronizating between the very basic and instinctive chemicals in our brains, the greater the need for the basic function of survival. When in withdrawal, many, many times our systems leap into the adrenaline overload state of 'fight or flight' and can be very unsettling; sweating, crazing heart rate increases, and no apparent reason for it; we could be simply trying to relax.
I found in the state of mind that I had put myself, I was able to go well into the afternoon before taking another 2 Hydro. Again, my body accepted them happily, but with a little decreased pleasure feeling again. I was then in a weird sort of bind. I asked myself, "Can I use the pleasure culprit to my advantage?" I knew that the longer I went without the Hydro, the more I would feel the pleasure in its effects; but now with controlled management of mind. I went very late into the evening before taking the drug again prior to sleeping. This was also partly planned so I could get sleep before work the next morning. Sure enough, I received more pleasure for my work in sticking it out. This was me manually using my inherent reward/pleasure system that is a natural occurrence. This REALLY helped me solidify many things. Primarily, that I was starting to side with my sense of survival more than that of pleasure, because I focused on the agony of misery over the reduced amount of pleasure; I started viewing Hydro as pain relief more than a pleasure giver, image that!With all this in mind, the continued process went pretty smooth. I really started feeling stable about a week into it. The RLS stayed, but lessened. Approximately a month later, I was convinced I had beaten it and 'shocked' my mind into unconsciously reacting with survival instinct when remembering the withdrawal experience, and in turn, putting kind of a fog over the memory of the pleasure the drug gave. During the entire process of withdrawal, I did go through mood swings, depression, lack of motivation, etc... But, I really believed that this was driven by a related but much different issue.
For me, this was where I compiled all all the logical facts. In short, everything pointed to a 'difference' in the chemical dance between my most basic chemicals. As stated before, I think in a different place and time, my balance may have been more closely balanced to the expectations of society. In 500 years from now, hypothetically, we may not require near the attention span as we do today due to such innovations as cortical implants. Maybe extremely focused attention capabilities would hinder a new age process in allowing your brain to completely relax during a 'neural stack upload'. Who really knows? Some of my own theories are part philosophical, psychological, biological, and spiritual. Furthermore, I think the meaning of life is to reach a point where all areas are completely in sync. But I will spare you any more of my thoughts and point you toward His Holiness, the Dali Lama who has done immense research, study, and contemplation on this very thing. I recently read his newest release, "The Universe in a Single Atom", read by Richard Gere.
So Jerry, you have a different issue. If you were able to get by without the Hydro from chronic pain and able to complete withdrawal from the drug, you would then have to consider the Adderall and the dopamine factor. You really have to think about how you feel? And remember, the natural brain's Opiates are to be managed and regulated by the dopamine. If you were able to 'fog' out the intense pleasure of the Hyrdo from it's initial use, you may feel small bursts of elation and inner happiness already and simply have yet to consciously noticed it. Your brain has just gone through trauma, so you may be getting all kinds of signals. Anything from sudden feeling of wanting to cry, or bursts of laughter...its hard to tell. Just keep your eye on the ball, and try to reset things and look at it with new, unbiased logic and less feeling. Keep a daily log through this entire process so you can track these feelings; it really helped me stay on track.
So, your quirk is the Addrall. I would guess it to be hard to gauge whether the Adderall is doing anything for you because you don't have a clean slate to measure from. I would suggest you, again, speak with your Doctor and ask his opinion on possibly reducing your Adderall intake for a period of time, then increasing again. This may help you feel the true benefits of correct Opiate management and a real feeling of the reward/pleasure instinct that drive the most successful and happiest people. Or, if you are only on a small dose of Adderall, ask about increasing it. I personally, due to my scientific nature, would have to completely come off the Adderall and spend a little time before starting up again. Again, that's my personality. I need to know that if I commit to something, I am getting the maximum benefit. So, when you feel ready, start with a dosage that you and your Doctor feel is right.
Sorry for such a long post, but if I am going to offer support to another that is seeking to improve their lives and need answers as much as I did, I feel you should know all the steps I took to correct my state of being. Also, many people will tell you that Adderall is bad, addictive, just a patch, etc. For some that is all they are because that's what their mind perceives them to be; and we all know how powerful the mind can be. In unbiased studies by the worlds top pharmacology, psychology, and biochemical governing institutes, Adderall, when used responsibly and correctly, is very unlikely to cause an addiction. So much that it has been legalized and prescribed to both children and adults. On a side note, I DO believe that it can be very addictive if used by an individual that has been misdiagnosed or used the drug for enhancement. That is why it is so important for us as individuals to treat Doctors as more of guides to understanding what is really going on inside. If you have a specific problem with how Dopamine handles the management of your pleasure/reward/motivation centers then a correct adjustment to that receptor has been shown repeatedly to improve many aspects of peoples lives. If you are using Adderall as a diet pill, or a study drug, then you are asking for real trouble. Obstructing a perfectly chemically sync'd neuronet may be just as devastating as heroin or cocaine, and may ultimately lead that person to addiction where normally there would not be a tendency for it. When individuals bring up the fact that the drug is just a temporary relief and your system will adapt build a tolerance, then think of the medication for people that are diabetic. They inject insulin into their system to control sugar levels. They have to ensure they use the correct dosage that is required to maintain a survivable blood sugar level. Now do Mr. Muscle at the local gym that uses insulin in a stacked concoction to increase hormones and muscle growth. Do we tell the person that is correcting their chemical balance with correct dosages of insulin that they can expect another 6 months on this Earthly planet before their systems build a tolerance?? And, do we applaud the guy that got all muscled up, lost the ability to reproduce, and is growing breasts, all to look good on the beach?? Drugs for ADD and other issues are all the same; they can help, or be abused. Do your homework; just ask my wife, I am a new man, awake and aware.
Disclaimer: For the purpose of my post and experience, I have used the brand Adderall. The brand or type of medication is not meant to condone its usage for anyone Else's struggles. It is up to the reader to determine where the unbalance, or dysfunction resides through their own personal research and professional assistance. If you can, also spend a couple sessions with a Psychologist when you are about to make a decision, just to ensure you are not biased by either the environment or internal conflict. Medications are simply our own bodies chemicals localized to ensure proper function...no different then Vitamin C to assist in the immune system. Just don't abuse it and ensure you completely understand your disorder before choosing a correcting medication.PS...Please forgive spelling and grammar, my brain was just returned to me. :)
Good luck, my prayers are with you!
SMPayne
Posted by jerrypharmstudent on July 22, 2007, at 20:07:17
In reply to Re: How I beat RLS and discovered ADD. » jerrypharmstudent, posted by smpayne69 on July 22, 2007, at 16:04:38
Great questions you raise and many things for me to think about. In short- I've been prescribe the hydrocodone as part of my depression treatment = mainly for dsthymia - so I guess the answer is party 'yes" to using it for the "feel good" part of it. However, in the 3-4 years I've been on it, I've never had to increase the dosage. I must be honest and say occasionally I have taken more than prescribed - but not handfuls and I'm not running out before my Rx is up.
With the Abilify I don't feel the need for the hydrocodone so much - that's why I want the Abilify to work and be able to go up to 5 mg.
I do not have a n addictive personality and my doctor monitors me very closely regarding both the adderall and hydrocodone. He's also read the studies I brought into my doctors in Minneapolis about the use of opiates in TRD. I certainly believe that they can be used in the wrong situations leading to addiction and terrible withdrawal- however, I also subscribe to the belief that they can certainly help a small a amount of patients out there who are severely TRD.
If/when I do go off of it - of course it will be a VERy slow taper. I want to eventually be on the least amount of meds as possible.
But I thank you for your post- it's gives me much to think about!
Thanks
Jerry
Posted by smpayne69 on July 22, 2007, at 20:50:38
In reply to Re: How I beat RLS and discovered ADD. » smpayne69, posted by jerrypharmstudent on July 22, 2007, at 20:07:17
Hey Jerry, it sounds like you have a plan...and of course the way you approach it may be much different than mine.
And I also totally agree about living life med free and happy. I would like to be there myself, but it will take time and more research.
For me, my only caution was the use a what drug for what purpose, because they can be confused. To your point with depression...the Opiate did help while in my system, but not the way I felt inside that it really should. My depression was largely caused from a long period of time fighting my attention and focus issues and desperately trying to keep up. The feeling of inner calm and happiness is not as accute as the initial spike an opiate may give, but over an entire day, the good feelings are so, so much better.
The best to you Jerry!
Shawn.
Posted by jerrypharmstudent on July 23, 2007, at 23:40:35
In reply to Restless Legs Syndrome?, posted by jerrypharmstudent on July 17, 2007, at 9:43:14
My doc gave me CONGENTIN ()benztropine) for my restlessness. I took my first dose and it seems to be helping a bit - but I read it may take a while for full beneficial effects.
Anyone know how this med works? I can seem to find it in my med books only that it is used for Parkinson's and restlessness from AP's. Says it's chemical make-up it close to that of atropine and diphenhydramine.
Any help would be appreciated.
Thanks
Jerry
Posted by Phillipa on July 23, 2007, at 23:49:49
In reply to Re: Restless Legs Syndrome-CONGENTIN, posted by jerrypharmstudent on July 23, 2007, at 23:40:35
Jerry well something is better than nothing. Love Phillipa
Benzatropine
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Benzatropine
Systematic (IUPAC) name
3-benzhydryloxy-8-methyl-8-azabicyclo[3.2.1]octane
Identifiers
CAS number 86-13-5
ATC code N04AC01
PubChem 1201549
DrugBank APRD00748
Chemical data
Formula C21H25NO
Mol. mass 307.429 g/mol
Pharmacokinetic data
Bioavailability ?
Metabolism ?
Half life 36 hours
Excretion ?
Therapeutic considerations
Pregnancy cat. C(US)
Legal status
Routes oral, IM, IV
Benzatropine mesilate (INN, commonly known as benztropine; marketed as Cogentin) is an anticholinergic drug principally used for the treatment of:Drug-induced parkinsonism, akathisia and acute dystonia;
Parkinson disease; and
Idiopathic or secondary dystonia.[edit] Indications
It is used in patients with schizophrenia to reduce the side effects of antipsychotic treatment, such as parkinsonism and akathisia.Benztropine is also a second-line drug for the treatment of Parkinson's disease. It improves tremor but not rigidity or bradykinesia.
Benztropine is also sometimes used for the treatment of dystonia, a rare disorder that causes abnormal muscle contraction, resulting in twisting postures of limbs, trunk, or face.
[edit] Side effects
These are principally anticholinergic:Dry mouth
Blurred vision
Cognitive changes
Constipation
Urinary retention
Tachycardia
Anorexia
Psychosis (usually in overdose)
Some studies suggest that use of anticholinergics increases the risk of tardive dyskinesia, a long-term side effect of antipsychotics.[1][2] Other studies have found no association between anticholinergic exposure and risk of developing tardive dyskinesia.[3][hide]v • d • eAnti-parkinson drugs: anticholinergic agents (N04A)
Tertiary amines Trihexyphenidyl - Biperiden - Metixene - Procyclidine - Profenamine - Dexetimide - Phenglutarimide - Mazaticol - Bornaprine - Tropatepine
Ethers chemically close to antihistamines Etanautine - Orphenadrine
Ethers of tropine or tropine derivatives
Posted by jerrypharmstudent on July 24, 2007, at 0:26:58
In reply to Re: Restless Legs Syndrome-CONGENTIN » jerrypharmstudent, posted by Phillipa on July 23, 2007, at 23:49:49
Posted by spriggy on July 24, 2007, at 0:38:49
In reply to Re: COGENTIN-thanks you (nm) (nm) » Phillipa, posted by jerrypharmstudent on July 24, 2007, at 0:26:58
Is there any way you can turn on babble mail so I can message you?
I have lots of questions and think you have the answers.
Thanks!
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