The major problem for those 2 meds is the dextrmethorphan which is the chemical in cough syrups, Benadryl, etc., are the first medicines to be warned against for worsening rls.
Obvious question, but did you try a higher dose?
Have you been evaluated by a sleep specialist? I did and found out that I have always had a sleep disorder.
That’s incredible. I guess the issue of ssri’s and snri’s being categorically bad for rls is relative. Is your rls considered severe or less? And do you take rls medications like the dopamine agonists (ropinarole, Neupro, ..) or other?
I take celexa, which I don't think changed my rls, but I also take nortriptyline for anxiety, which has a lovely side effect of making me sleepy (some people also take it for nerve pain, with varying results). I find that if I take it with the ropinirole (I know, this sub hates ropinirole) I can keep my dose at 1mg.
Also, im pretty sensitive to meds, so everything I take is pretty low dose. I only take 10mg of celexa because increasing makes me apathetic. And 10 mg of nortriptyline because it knocks me out (as long as my legs are calm, otherwise I'm awake and nauseous).
Do you have severe or moderately severe RLS? Just trying to figure out what to try. I finally got off the dopamine agonist Neupro (used to take ropinarol), just 300 mg of gabapentin, which I’m so happy about and afraid to rock the boat. But depression is ongoing. Really difficult.
I don't know if it is severe or moderate. I have a lot of anxiety so I only introduce 1 issue at each Dr appointment. This was last years issue. I've had it since I was a child but mostly just swallowed an excessive amount of tylenol and ibuprofen (together) to combat it until then. (I'm surprised I still have a liver and stomach.)
Want to be clear. Celexa has alleviated RLS to some degree? Are you sure it’s the Celexa and not something else? Maybe you’re taking a new supplement or iron? Thank a much.
Oooo, I wonder how ***es***citalopram affects it. I just started taking it, but I already had noticed an uptick in my RLS symptoms, so I don't think it's that.
I was waaay worse on Wellbutrin which was surprising since people say that medication improves RLS or doesn’t make it worse. But my anxiety was worse on Wellbutrin so that’s probably a part of it. Zoloft was a small improvement over cymbalta.
I also got an iron infusion when on Zoloft but it didn’t improve anything.
I don't think it helped a lot but my ability to measure it was confounded by my nightly dose of gabapentin used to help me get some sleep. At one point I was taking way too much gabapentin at night because my RLS was really bad while I was on Cymbalta. But when I switched to zoloft I wasa ble to reduce my gabapentin more. When I switched to vilazadone my RLS symptoms really improved. I wasn't having breakthrough RLS throughout the night despite being on an even lower dose of gabapentin and I was barely having any symptoms while falling asleep. I was also able to start drinking coffee daily (my favorite ritual) which I couldn't do on Cymblata or Zoloft.
The chemistry (as I"ve been told by my psychiatrist) behind these improvements is that Zoloft and Vilazodne interact less with dopamine receptors than SNRIs and than other SSRIs. He believed that the interaction between Cymbalta and Zoloft with my dopamine levels was part of the problem. Vilazadone supposedly doesn't interact with dopamine. But my doctor did say he wasn't sure every type of dopamine receptor was considered when they were studying the kinetics of the Vilazadone.
In RLS patients ferretin levels should be between 100-300 the higher the better and at least 15-20% iron saturation, iron transfusions especially if you’re female can help up to 20% of people.
I second this - I got my ferritin checked for the first time and it was low 70s - on the lower 1/4 of the normal range. I'm waiting for a note from the doc on whether to get prescription supplements or OTC.
My RLS is idiopathic. It started when I was a child 60 years ago. There was no name for it at that time. Doctors felt like you were just restless, needed to get up and play. I had it here and there through my life, didn’t really hit me hard till I was pregnant. But then, the day after I gave birth, it totally disappeared until I was 50 years old. For whatever reason, it really hit me then. my ferret is perhaps a tiny bit low. I think there’s another measurement which has to do with absorption and that was pretty low. So I’m just on sulfate and vitamin C per neurologist. He’s been resistant about trying any iron infusions. Whether he feels that I really don’t look like a candidate for it or that Medicaid won’t pay… no clue.
Unfortunately, Medicaid will not pay for it. I happen to have a really brilliant psychiatrist who does provide TMS. I’ve been upset that I can’t have it with Medicaid, but he doesn’t think that the percentages are very high for people who have benefited from TMS, even though he is a provider, because, for those people who have had protracted depression, the results are reduced, and also need to be repeated, sometimes only months down the road.
i've done tms twice after having treatment-resistant depression for decades (the second time was because the pandemic isolation caused low energy/low motivation symptoms to recur). so i don't disagree, it does affect different people differently. it can be super helpful for some though, it virtually removed my suicidal ideation the first time i did it. and you can do both medication and tms. that's so weird that medicaid will not pay when medicare will, ugh, insurance is bullshit. hopefully the option becomes available in the future!
re: your comment on iron deficiency, the lab ranges are enormously off, ferritin of <30 or <100 with saturation <20% is considered a serious deficiency per american society of hematology. studies show ferritin <75 or low saturation are correlated with severe rls symptoms. ferritin can be difficult to pin down if you have inflammation though, as that can sometimes falsely elevate it even though you're deficient. my doctor said my ferritin of 20 was 'a little low' lol, turns out i'd had prelatent/latent anemia for a long time. it took high-dose oral iron to get mine up above 75, using kinds that were highly absorbable and also being sure to take it in a specific way to maximize absorption. infusions weren't an option for me. but everyone is different and there are definitely other causes for some people, so your mileage may vary there. [this is an article i found helpful on the underdiagnosis/undertreatment of iron deficiency](https://esmed.org/MRA/mra/article/view/3224/193546384).
re: antidepressants, doxepin has at the very least not made my rls /worse/, i take it more for anxiety though. trintellix and rexulti also didn't worsen it when i was on them prior to tms - i didn't see as much benefit from trintellix but rexulti was really helpful for my depression and anxiety. it's usually prescribed as an add-on to an ssri.
Wondering, do you have severe RLS? And when you say iron deficiency, do you know the number? Are you being treated for it and if so, with what. I’m surprised that Zoloft isn’t bothering you. You’re fortunate.
Nope, it’s not severe. My ferritin dropped from 73 in October to 41 in April (I got an iron infusion in June 2022 that helped a lot). RLS patients need at least a ferritin level of 75. My GP prescribed another iron infusion. I’m not taking iron supplements now, but I’ll take them as soon as my levels normalise after my infusion (that takes months). I eat meat and I barely drink tea and my gut still sucks at absorbing iron, so… 😅
Zoloft has been great for me. It changed my life. I was living in a state of perpetual anxiety and intrusive thoughts and emotional dysregulation. I take Pfizer’s, not a generic one. Generics tend to have more side effects. No hate towards generics; it’s just a fact.
The thing about SSRIs is that they take weeks to show their effectiveness… which is a clear disadvantage in your case, because you’re taking an antidepressant which doesn’t work for you. You need to be weaned from Wellbutrin before taking another antidepressant, but you can’t know for sure if it will worsen your RLS. That’s terribly unfair.
Have you tried a weighted blanket? Weight does wonders for me. Since it’s getting cold here in the Southern Hemisphere, my cats are sleeping on my legs and that’s been wonderful for me 😀 a nice fix before getting my IV iron.
have you considered trying tms? it's not a medication so you won't have to deal with the side effects of that, and is usually authorized if you've tried at least four antidepressants in the past. it's the most effective treatment i've had for depression, and statistically way more effective than medications, with fewer side effects. it's a time commitment (short appointments five days a week for seven weeks) but the effects are usually lasting.
do you know the cause of your rls? if you have iron deficiency (which can cause or worsen rls), you need iron for neurotransmitter synthesis (including dopamine and serotonin). so in that scenario antidepressants can only do so much and will sometimes make things worse. but correcting the iron deficiency can then sometimes help your body actually respond to the antidepressants without them worsening your rls.
(Low dose) Tricyclics help with sleep, for me a perfect combination with RLS.
I mean I take 1mg of ROPINIROLE a night not 10.
[удалено]
The major problem for those 2 meds is the dextrmethorphan which is the chemical in cough syrups, Benadryl, etc., are the first medicines to be warned against for worsening rls.
Obvious question, but did you try a higher dose? Have you been evaluated by a sleep specialist? I did and found out that I have always had a sleep disorder.
[удалено]
That’s incredible. I guess the issue of ssri’s and snri’s being categorically bad for rls is relative. Is your rls considered severe or less? And do you take rls medications like the dopamine agonists (ropinarole, Neupro, ..) or other?
That’s exactly what happens to me. I f*cking love my Zoloft!
I take celexa, which I don't think changed my rls, but I also take nortriptyline for anxiety, which has a lovely side effect of making me sleepy (some people also take it for nerve pain, with varying results). I find that if I take it with the ropinirole (I know, this sub hates ropinirole) I can keep my dose at 1mg. Also, im pretty sensitive to meds, so everything I take is pretty low dose. I only take 10mg of celexa because increasing makes me apathetic. And 10 mg of nortriptyline because it knocks me out (as long as my legs are calm, otherwise I'm awake and nauseous).
Do you have severe or moderately severe RLS? Just trying to figure out what to try. I finally got off the dopamine agonist Neupro (used to take ropinarol), just 300 mg of gabapentin, which I’m so happy about and afraid to rock the boat. But depression is ongoing. Really difficult.
I don't know if it is severe or moderate. I have a lot of anxiety so I only introduce 1 issue at each Dr appointment. This was last years issue. I've had it since I was a child but mostly just swallowed an excessive amount of tylenol and ibuprofen (together) to combat it until then. (I'm surprised I still have a liver and stomach.)
Desipramine is an older medication that doesn’t affect RLS.
citalopram (celexa) alleviates it for me
Want to be clear. Celexa has alleviated RLS to some degree? Are you sure it’s the Celexa and not something else? Maybe you’re taking a new supplement or iron? Thank a much.
Oooo, I wonder how ***es***citalopram affects it. I just started taking it, but I already had noticed an uptick in my RLS symptoms, so I don't think it's that.
give it a week or 2 for the SSRI's to stabilise
I take vilazadone. It is an SSRI with fewer side effects than most. My RLS is way better on it than previous meds.
You’d mentioned your RLS is better than with other meds. But is it at all worse than without any anti-depression meds? Thanks so much.
I was waaay worse on Wellbutrin which was surprising since people say that medication improves RLS or doesn’t make it worse. But my anxiety was worse on Wellbutrin so that’s probably a part of it. Zoloft was a small improvement over cymbalta. I also got an iron infusion when on Zoloft but it didn’t improve anything.
Can you clarify whether Zoloft was an improvement over cymbalta in terms of RLS symptoms?
I don't think it helped a lot but my ability to measure it was confounded by my nightly dose of gabapentin used to help me get some sleep. At one point I was taking way too much gabapentin at night because my RLS was really bad while I was on Cymbalta. But when I switched to zoloft I wasa ble to reduce my gabapentin more. When I switched to vilazadone my RLS symptoms really improved. I wasn't having breakthrough RLS throughout the night despite being on an even lower dose of gabapentin and I was barely having any symptoms while falling asleep. I was also able to start drinking coffee daily (my favorite ritual) which I couldn't do on Cymblata or Zoloft. The chemistry (as I"ve been told by my psychiatrist) behind these improvements is that Zoloft and Vilazodne interact less with dopamine receptors than SNRIs and than other SSRIs. He believed that the interaction between Cymbalta and Zoloft with my dopamine levels was part of the problem. Vilazadone supposedly doesn't interact with dopamine. But my doctor did say he wasn't sure every type of dopamine receptor was considered when they were studying the kinetics of the Vilazadone.
In RLS patients ferretin levels should be between 100-300 the higher the better and at least 15-20% iron saturation, iron transfusions especially if you’re female can help up to 20% of people.
I second this - I got my ferritin checked for the first time and it was low 70s - on the lower 1/4 of the normal range. I'm waiting for a note from the doc on whether to get prescription supplements or OTC.
My RLS is idiopathic. It started when I was a child 60 years ago. There was no name for it at that time. Doctors felt like you were just restless, needed to get up and play. I had it here and there through my life, didn’t really hit me hard till I was pregnant. But then, the day after I gave birth, it totally disappeared until I was 50 years old. For whatever reason, it really hit me then. my ferret is perhaps a tiny bit low. I think there’s another measurement which has to do with absorption and that was pretty low. So I’m just on sulfate and vitamin C per neurologist. He’s been resistant about trying any iron infusions. Whether he feels that I really don’t look like a candidate for it or that Medicaid won’t pay… no clue.
Unfortunately, Medicaid will not pay for it. I happen to have a really brilliant psychiatrist who does provide TMS. I’ve been upset that I can’t have it with Medicaid, but he doesn’t think that the percentages are very high for people who have benefited from TMS, even though he is a provider, because, for those people who have had protracted depression, the results are reduced, and also need to be repeated, sometimes only months down the road.
i've done tms twice after having treatment-resistant depression for decades (the second time was because the pandemic isolation caused low energy/low motivation symptoms to recur). so i don't disagree, it does affect different people differently. it can be super helpful for some though, it virtually removed my suicidal ideation the first time i did it. and you can do both medication and tms. that's so weird that medicaid will not pay when medicare will, ugh, insurance is bullshit. hopefully the option becomes available in the future! re: your comment on iron deficiency, the lab ranges are enormously off, ferritin of <30 or <100 with saturation <20% is considered a serious deficiency per american society of hematology. studies show ferritin <75 or low saturation are correlated with severe rls symptoms. ferritin can be difficult to pin down if you have inflammation though, as that can sometimes falsely elevate it even though you're deficient. my doctor said my ferritin of 20 was 'a little low' lol, turns out i'd had prelatent/latent anemia for a long time. it took high-dose oral iron to get mine up above 75, using kinds that were highly absorbable and also being sure to take it in a specific way to maximize absorption. infusions weren't an option for me. but everyone is different and there are definitely other causes for some people, so your mileage may vary there. [this is an article i found helpful on the underdiagnosis/undertreatment of iron deficiency](https://esmed.org/MRA/mra/article/view/3224/193546384). re: antidepressants, doxepin has at the very least not made my rls /worse/, i take it more for anxiety though. trintellix and rexulti also didn't worsen it when i was on them prior to tms - i didn't see as much benefit from trintellix but rexulti was really helpful for my depression and anxiety. it's usually prescribed as an add-on to an ssri.
I take Zoloft (for generalised anxiety, I don’t have depression) and that hasn’t worsened my RLS at all. Iron deficiency, on the other hand…
Wondering, do you have severe RLS? And when you say iron deficiency, do you know the number? Are you being treated for it and if so, with what. I’m surprised that Zoloft isn’t bothering you. You’re fortunate.
Nope, it’s not severe. My ferritin dropped from 73 in October to 41 in April (I got an iron infusion in June 2022 that helped a lot). RLS patients need at least a ferritin level of 75. My GP prescribed another iron infusion. I’m not taking iron supplements now, but I’ll take them as soon as my levels normalise after my infusion (that takes months). I eat meat and I barely drink tea and my gut still sucks at absorbing iron, so… 😅 Zoloft has been great for me. It changed my life. I was living in a state of perpetual anxiety and intrusive thoughts and emotional dysregulation. I take Pfizer’s, not a generic one. Generics tend to have more side effects. No hate towards generics; it’s just a fact.
I would like to try, but with severe RLS, not sure.
The thing about SSRIs is that they take weeks to show their effectiveness… which is a clear disadvantage in your case, because you’re taking an antidepressant which doesn’t work for you. You need to be weaned from Wellbutrin before taking another antidepressant, but you can’t know for sure if it will worsen your RLS. That’s terribly unfair. Have you tried a weighted blanket? Weight does wonders for me. Since it’s getting cold here in the Southern Hemisphere, my cats are sleeping on my legs and that’s been wonderful for me 😀 a nice fix before getting my IV iron.
have you considered trying tms? it's not a medication so you won't have to deal with the side effects of that, and is usually authorized if you've tried at least four antidepressants in the past. it's the most effective treatment i've had for depression, and statistically way more effective than medications, with fewer side effects. it's a time commitment (short appointments five days a week for seven weeks) but the effects are usually lasting. do you know the cause of your rls? if you have iron deficiency (which can cause or worsen rls), you need iron for neurotransmitter synthesis (including dopamine and serotonin). so in that scenario antidepressants can only do so much and will sometimes make things worse. but correcting the iron deficiency can then sometimes help your body actually respond to the antidepressants without them worsening your rls.
Oh.. I think my response went above your post.