Shown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by g_g_g_unit on September 16, 2010, at 23:07:56
I'm having these like crazy on the Anafranil. In fact, they pretty much negate any benefits it has on sleep because I'm constantly being awoken by my own flailing body. What to do, what to do? Will they pass?
Posted by ed_uk2010 on September 17, 2010, at 13:19:47
In reply to Leg jerks on serotonergic meds. . ., posted by g_g_g_unit on September 16, 2010, at 23:07:56
>What to do, what to do? Will they pass?
A reduced dose may be the most appropriate place to start. That's what I'd try anyway.
Posted by Maxime on September 17, 2010, at 21:36:18
In reply to Leg jerks on serotonergic meds. . ., posted by g_g_g_unit on September 16, 2010, at 23:07:56
I am sorry that you are having problems with the med. How long will you stick with it? At least you are trying ... don't give up.
Posted by g_g_g_unit on September 18, 2010, at 1:48:40
In reply to Re: Leg jerks on serotonergic meds. . ., posted by ed_uk2010 on September 17, 2010, at 13:19:47
> >What to do, what to do? Will they pass?
>
> A reduced dose may be the most appropriate place to start. That's what I'd try anyway.
>
>I'm only on 100mg, and have been experiencing them with each subsequent titration since I started at 25mg a week ago. Do you know what causes them, Ed? Is it typically a transient problem?
Posted by g_g_g_unit on September 18, 2010, at 1:55:38
In reply to Re: Leg jerks on serotonergic meds. . . » g_g_g_unit, posted by Maxime on September 17, 2010, at 21:36:18
> I am sorry that you are having problems with the med. How long will you stick with it? At least you are trying ... don't give up.
Thanks. I'm typically so ambivalent about the prospect of being on a given med, that I'll take any inconvenient side-effect as an excuse to jump ship. But I've tried so much stuff - and my OCD has reached such distressing heights - that this is the one instance where I *do* desperately want to remain on the drug at all costs.
I'm seeing my psychiatrist at the end of next week, so certainly will remain on it until then. The last time this leg-jerking problem appeared, my p-doc at the time wanted to prescribe clonazepam as a remedy, but I just hate the idea of medicating side-effects, particularly with benzos.
Posted by Maxime on September 18, 2010, at 9:53:19
In reply to Re: Leg jerks on serotonergic meds. . . » Maxime, posted by g_g_g_unit on September 18, 2010, at 1:55:38
You can take Cogentin for the leg twiching/jerking. It's not a benzo. It is usually prescribed with one is taking an anti psychotic.
You should look it up!
Posted by bleauberry on September 18, 2010, at 15:20:02
In reply to Leg jerks on serotonergic meds. . ., posted by g_g_g_unit on September 16, 2010, at 23:07:56
From an overly simplistic view, leg jerks caused by a serotonergic antidepressant are basically indications of inadequate dopamine function. Dopamine is closely related to movement disorders of many kinds. That's why dopamine agonists are commonly used in restless leg syndrome, parkinsons, and such. It could simply be that your dopamine was weak and vulnerable to begin with, and perhaps even a factor in the mood problems.
The TCAs have a lot of affinities though...histamine, choline, etc, so it's really hard to know all the interplay going on.
It is a neurological disorder, not a psychiatric disorder. The artificially flooded levels of serotonin just happened to unmask it, probably by squashing out dopamine. But anything is possible.
I would not view it as a "side effect". It is a direct effect of some kind and is sending clues. Personally, a neurological thing that like would scare me off the drug. It would basically be my body saying, "no no no, wrong drug".
Posted by ed_uk2010 on September 18, 2010, at 16:30:08
In reply to Re: Leg jerks on serotonergic meds. . . » ed_uk2010, posted by g_g_g_unit on September 18, 2010, at 1:48:40
>I'm only on 100mg, and have been experiencing them with each subsequent titration since I started at 25mg a week ago. Do you know what causes them, Ed? Is it typically a transient problem?
100mg isn't that low, clomipramine is powerful stuff. It can certainly be effective at 100mg, so I would avoid any further increases, at least for the next month or so.
Twitching of the legs seems to result from excessive increases in serotonin. It is particularly likely with combinations of more than one serotonergic drug. I think it is a sign that 100mg is more than enough.
Posted by Maxime on September 18, 2010, at 16:34:06
In reply to Re: Leg jerks on serotonergic meds. . ., posted by bleauberry on September 18, 2010, at 15:20:02
If I remember correctly, taking Magnesium helps, but I can't remember for sure ...
Posted by g_g_g_unit on September 18, 2010, at 21:21:22
In reply to Re: Leg jerks on serotonergic meds. . ., posted by bleauberry on September 18, 2010, at 15:20:02
> From an overly simplistic view, leg jerks caused by a serotonergic antidepressant are basically indications of inadequate dopamine function. Dopamine is closely related to movement disorders of many kinds. That's why dopamine agonists are commonly used in restless leg syndrome, parkinsons, and such. It could simply be that your dopamine was weak and vulnerable to begin with, and perhaps even a factor in the mood problems.
>
> The TCAs have a lot of affinities though...histamine, choline, etc, so it's really hard to know all the interplay going on.
>
> It is a neurological disorder, not a psychiatric disorder. The artificially flooded levels of serotonin just happened to unmask it, probably by squashing out dopamine. But anything is possible.
>
> I would not view it as a "side effect". It is a direct effect of some kind and is sending clues. Personally, a neurological thing that like would scare me off the drug. It would basically be my body saying, "no no no, wrong drug".Thanks for your help. I do suffer from comorbid ADD, which I guess is a 'dopamine disorder' in certain respects, and AD's have also uncovered Restless Leg Syndrome in me. Unfortunately, there's no way I can treat my depression/OCD without being on an SRI of some sorts.
Posted by g_g_g_unit on September 18, 2010, at 21:27:30
In reply to Re: Leg jerks on serotonergic meds. . . » g_g_g_unit, posted by ed_uk2010 on September 18, 2010, at 16:30:08
> 100mg isn't that low, clomipramine is powerful stuff. It can certainly be effective at 100mg, so I would avoid any further increases, at least for the next month or so.Ah okay. My impression was that 100mg is insufficient in treating OCD.
>
> Twitching of the legs seems to result from excessive increases in serotonin. It is particularly likely with combinations of more than one serotonergic drug. I think it is a sign that 100mg is more than enough.
>Hmm. There are accounts in the archives where people experienced twitching for a week or so on Lexapro, Effexor, etc., but then it subsided. However, would 100mg of clomipramine be providing far more serotonin reuptake inhibition than an equivalent therapeutic dose of, say, Effexor? I'm just curious because that was my psychiatrist's first recommendation to me and I'm wondering if I could bypass a lot of these intrusive s/e's by switching.
Posted by ed_uk2010 on September 19, 2010, at 8:08:02
In reply to Re: Leg jerks on serotonergic meds. . . » ed_uk2010, posted by g_g_g_unit on September 18, 2010, at 21:27:30
>Ah okay. My impression was that 100mg is insufficient in treating OCD
It will be insufficient for some, but enough for others. Metabolism and response to all TCAs is very variable.
>However, would 100mg of clomipramine be providing far more serotonin reuptake inhibition than an equivalent therapeutic dose of, say, Effexor?
Not really. I expect that at least 80% of transporters are blocked, which is similar to moderate doses of other SRIs.
>I'm just curious because that was my psychiatrist's first recommendation to me and I'm wondering if I could bypass a lot of these intrusive s/e's by switching.
Perhaps, Effexor and clomipramine both cause more adverse effects than standard SSRIs such as Lexapro. Effexor (and possibly clomipramine) also causes more severe withdrawal symptoms.
If the leg twitching is your main problem I would start by reducing the dose a little. Give it a chance before increasing any further. If the twitching doesn't resolve after a couple of weeks on a lower dose, try something else.
Posted by g_g_g_unit on September 23, 2010, at 5:12:28
In reply to Re: Leg jerks on serotonergic meds. . ., posted by ed_uk2010 on September 19, 2010, at 8:08:02
hey ed -
I just wanted to thank you for all your advice. Are you a pharmacy student, or just a med hobbyist?
I saw my psychiatrist today and reported the muscle-twitching issue, but she didn't regard it as anything to be concerned about. She said I could raise the dose further - to 125 or 150mg - but I emphasized my concern about the sleep disturbances I was having, and she said that in that case, I should hang around at 100mg and see how I proceed. The jerks aren't as bad at this stage, and I generally feel adequately rested when I wake up, but there are black circles under my eyes each morning, so I know something's up . .
Anyway, I found 25-75mg was helping me get to sleep, but 100mg isn't, so I've been thinking about splitting up the dose. Do you have any advice on TCA dosing? Would 50mg in the morning and 50mg at night be standard practice?
Posted by creepy on September 23, 2010, at 12:37:25
In reply to Leg jerks on serotonergic meds. . ., posted by g_g_g_unit on September 16, 2010, at 23:07:56
Clomipramine antagonizes D2 directly. Aside from the blocking you may get with SSRIs, that might be an explanation. If thats the case the previous post suggesting cogentin might be helpful. Maybe even just over the counter benadryl.
Depending on why you take it, adding a dopamine agonist may not be a good idea.
Posted by Conundrum on September 23, 2010, at 13:26:32
In reply to Re: Leg jerks on serotonergic meds. . ., posted by creepy on September 23, 2010, at 12:37:25
Are you the same creepy as the one on crazymeds forum?
Posted by g_g_g_unit on September 23, 2010, at 21:28:39
In reply to Re: Leg jerks on serotonergic meds. . ., posted by creepy on September 23, 2010, at 12:37:25
> Clomipramine antagonizes D2 directly.
interesting. do you have any cites?
Posted by ed_uk2010 on September 28, 2010, at 17:21:43
In reply to Re: Leg jerks on serotonergic meds. . . » ed_uk2010, posted by g_g_g_unit on September 23, 2010, at 5:12:28
>I've been thinking about splitting up the dose. Do you have any advice on TCA dosing? Would 50mg in the morning and 50mg at night be standard practice?
Traditionally, TCAs were often given as three doses per day, often with the largest dose at night. Now, they are more commonly given as a single daily dose in the evening.
Taking 50mg twice a day should be fine, or you could try 25mg in the morning and 75mg at night.
Posted by creepy on October 1, 2010, at 8:45:58
In reply to Re: Leg jerks on serotonergic meds. . ., posted by g_g_g_unit on September 23, 2010, at 21:28:39
This is the end of the thread.
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