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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by g_g_g_unit on September 13, 2009, at 16:24:44
every drug i go on seems to give me the worst restless legs at night! the effect even managed to break through my seroquel-induced coma last night, wrecking my sleep. i was wondering whether the meds might be exacerbating an underlying condition i should look into, or this just a temporary side-effect liable to strike anyone?
Posted by linkadge on September 13, 2009, at 17:10:15
In reply to meds + restless leg, posted by g_g_g_unit on September 13, 2009, at 16:24:44
What meds are you taking? Antidopaminergics are probably the worst offenders.
Linkadge
Posted by g_g_g_unit on September 13, 2009, at 17:17:53
In reply to Re: meds + restless leg, posted by linkadge on September 13, 2009, at 17:10:15
> What meds are you taking? Antidopaminergics are probably the worst offenders.
>
> Linkadgeparnate 20mg (started a week ago) and 25mg of Seroquel at night
Posted by fattoush on September 13, 2009, at 17:47:59
In reply to Re: meds + restless leg, posted by g_g_g_unit on September 13, 2009, at 17:17:53
Seroquel did it for me but at a much higher dose, between 100 and 150. Perhaps you're particularly sensitive to it.
Posted by g_g_g_unit on September 13, 2009, at 18:11:04
In reply to Re: meds + restless leg, posted by fattoush on September 13, 2009, at 17:47:59
> Seroquel did it for me but at a much higher dose, between 100 and 150. Perhaps you're particularly sensitive to it.
that sucks if it is the Seroquel. pretty much defeats its purpose as a sleep aid
Posted by heimholtz on September 13, 2009, at 20:58:32
In reply to Re: meds + restless leg, posted by g_g_g_unit on September 13, 2009, at 18:11:04
> > Seroquel did it for me but at a much higher dose, between 100 and 150. Perhaps you're particularly sensitive to it.
>
> that sucks if it is the Seroquel. pretty much defeats its purpose as a sleep aid
>I have really bad RLS. Seroquel made is worse and didn't really put me down. Zyprexa worked much better for me. It didn't aggravate the RLS and it knocks me out.
Posted by sowhysosad on September 14, 2009, at 20:35:28
In reply to Re: meds + restless leg, posted by linkadge on September 13, 2009, at 17:10:15
> What meds are you taking? Antidopaminergics are probably the worst offenders.
And yet I read the other day that, ironically, Seroquel is often prescribed off-label for RLS!
Posted by linkadge on September 15, 2009, at 10:27:05
In reply to Re: meds + restless leg » linkadge, posted by sowhysosad on September 14, 2009, at 20:35:28
>And yet I read the other day that, ironically, >Seroquel is often prescribed off-label for RLS!
Yeah, the sedative effects may mask RLS symptoms, but probably not hitting the target.
g_g_g_unit: a low dose TCA may help with sleep with less of an antidopaminergic effect.
Linkadge
Posted by sowhysosad on September 15, 2009, at 11:45:45
In reply to Re: meds + restless leg, posted by linkadge on September 15, 2009, at 10:27:05
> Yeah, the sedative effects may mask RLS symptoms, but probably not hitting the target.
That's what I thought - and perhaps it improves the quality of sleep too.
I'm sure you're spot-on when you say insufficient dopamine (in the substantia nigra perhaps?) is the cause.
My soon-to-be-ex-wife has undiagnosed RLS from long-term escitalopram use. Our inability to share a bed because of it was one of the factors that precipitated the breakdown of the relationship.
RLS can have a really negative effect on people's quality of life.
Posted by linkadge on September 15, 2009, at 16:48:04
In reply to Re: meds + restless leg, posted by sowhysosad on September 15, 2009, at 11:45:45
>That's what I thought - and perhaps it improves >the quality of sleep too.
>I'm sure you're spot-on when you say >insufficient dopamine (in the substantia nigra >perhaps?) is the cause.
Yeah. It seems that RLS is on the rise. I never remember it being big say 10 years back. Perhaps its rise paralells the increase in SSRI use.
SSRI's can cause a host of 'bedtime' issues. Loss of interest/ability to have sex as well as insomnia and RLS.
Linkadge
Posted by g_g_g_unit on September 15, 2009, at 18:57:28
In reply to Re: meds + restless leg, posted by linkadge on September 15, 2009, at 10:27:05
> g_g_g_unit: a low dose TCA may help with sleep with less of an antidopaminergic effect.
>
> Linkadgethanks. maybe i will run the idea past my pdoc, though i don't know how well versed in polypharmacy he is; he may just assume MAOI + TCA = BRAIN MELT.
i've started exercising more and that seems to have helped the RLS a bit.
Posted by sowhysosad on September 15, 2009, at 19:35:48
In reply to Re: meds + restless leg, posted by linkadge on September 15, 2009, at 16:48:04
> Yeah. It seems that RLS is on the rise. I never remember it being big say 10 years back. Perhaps its rise paralells the increase in SSRI use.
I bet you're right on that one.
Also, perhaps it was around much more than we thought a decade ago, but didn't come to prominence until drugs to combat it were more heavily marketed.
> SSRI's can cause a host of 'bedtime' issues. Loss of interest/ability to have sex as well as insomnia and RLS.
Tell me about it. Early morning awakening on fluoxetine is hideous.
That said, the slightly reduced sensitivity and delayed climax during sex has actually been quite useful (not that I'm likely to have sex at any point in the near future due to recent events!).
Posted by cactus on September 15, 2009, at 19:46:51
In reply to Re: meds + restless leg, posted by g_g_g_unit on September 15, 2009, at 18:57:28
clonazepam and valium worked best for me. Anti Psychotic's are terrible for RLS, one of the worst offenders as with anti histamines which are similar, then again DA's, like Mirapex and Repreve/Requip can cause augmentation down the track and end up making it worse, along with l-dopa too, which are all anti parkinsons. Check out RLS.org
I got some great info from there, but I'm sure you've already looked into them.
Exercise does help but make sure you have you kidneys checked, actually your entire renal system, that is another major cause of RLS. RSL blows, Peace C
Opiates are also excellent but like the benzos are addictive.
There are some epileptic meds that have had great success too, good luck and I personally would get rid of the seroquel asap if you can. If you're only using it for sleep then ditch it straight away but if it's for something else talk it through with your pdoc. Most pdocs will tell you AP's don't affect RLS which is a very big lie for the vast majority of sufferers. The 3 I've tried affected it terribly and same with sedating anti-histamines, but non sedating anti-histamines are ok for me.
Posted by sowhysosad on September 15, 2009, at 20:07:56
In reply to Re: meds + restless leg » g_g_g_unit, posted by cactus on September 15, 2009, at 19:46:51
> one of the worst offenders as with anti histamines which are similar
That's interesting. The soon-to-be-ex Mrs Sad was hitting the antihistamines over the Summer for hay fever which could have made her RLS worse.
I wonder if it's because some of them are also weak SRI's?
> then again DA's, like Mirapex and Repreve/Requip can cause augmentation down the track and end up making it worse
That's a bit worrying considering dopamine agonists are the most commonly prescribed meds for RLS!
What do you mean by "cause augmentation down the track"?
> Opiates are also excellent but like the benzos are addictive.I was interested to read that the other day.
Maybe it's because opiates cause (I believe) dopmamine release through a glutamate-mediated mechanism.
Posted by g_g_g_unit on September 15, 2009, at 21:33:29
In reply to Re: meds + restless leg » g_g_g_unit, posted by cactus on September 15, 2009, at 19:46:51
the side effect only began to appear once i went on SSRI's, so i doubt it's kidney related.
i should add that i'm not taking Seroquel to treat RLS - i'm using it as a band-aid for Parnate-induced insomnia. unfortunately, the Seroquel caused the RLS to reemerge.
i'm seeing my pdoc again in 3 weeks, and can't really afford to see him any sooner. i'm happy to put up with the RL as long as the Parnate insomnia goes away eventually.
forgive my naivete, but i thought since Parnate increases dopamine, it would help combat the RL. maybe my dose (20mg) is too low for much MAO-B inhbition?
Posted by cactus on September 15, 2009, at 22:06:59
In reply to Re: meds + restless leg » cactus, posted by sowhysosad on September 15, 2009, at 20:07:56
> > one of the worst offenders as with anti histamines which are similar
>
> That's interesting. The soon-to-be-ex Mrs Sad was hitting the antihistamines over the Summer for hay fever which could have made her RLS worse.
*if they were sedating ones, then a very big yes*
>
> I wonder if it's because some of them are also weak SRI's?
>
> > then again DA's, like Mirapex and Repreve/Requip can cause augmentation down the track and end up making it worse
>
> That's a bit worrying considering dopamine agonists are the most commonly prescribed meds for RLS!
*yes it's actually a massive concern that not many people know about and they have a short life span for most too, with RLS. They are for Parkinson's Disease not RLS. They work like a miracle at first*
>
> What do you mean by "cause augmentation down the track"?
*Augmentation in relation to RLS means it comes back worse than it originally was for some people. Repreve/Requip was fantastic, and it also blew my depression out of the water but it also made me blow chunks so I had to stop after 3 months. The thought of RLS getting worse was not a pleasent thought, which I found out about after reading the boards at rsl.org, Luckily my body couldn't tolerate them so I never had to find out the hard way*
>
>
> > Opiates are also excellent but like the benzos are addictive.
>
> I was interested to read that the other day.
>
> Maybe it's because opiates cause (I believe) dopmamine release through a glutamate-mediated mechanism.*I don't know about that, they just make me sick, so I stick to benzos*
Posted by cactus on September 15, 2009, at 22:27:28
In reply to Re: meds + restless leg, posted by g_g_g_unit on September 15, 2009, at 21:33:29
I've never tried Parnate, but anything that promotes dopamine properties stops my RLS. Ask for some clonazepam instead of seroquel, just 2 weeks worth and see what happens.
Posted by g_g_g_unit on September 16, 2009, at 2:22:10
In reply to Re: meds + restless leg » g_g_g_unit, posted by cactus on September 15, 2009, at 22:27:28
> I've never tried Parnate, but anything that promotes dopamine properties stops my RLS. Ask for some clonazepam instead of seroquel, just 2 weeks worth and see what happens.
i"d rather not end up hooked on clonazepam and then have to withdraw. the idea behind seroquel was that at least it isn't addictive, since i build tolerance to benzos really quickly when trying to sleep on an MAOI
Posted by SLS on September 16, 2009, at 5:58:55
In reply to Re: meds + restless leg » g_g_g_unit, posted by cactus on September 15, 2009, at 22:27:28
Here's a nice little study associating SRI use with RLS:
- Scott
Posted by sowhysosad on September 16, 2009, at 11:23:18
In reply to Re: meds + restless leg, posted by g_g_g_unit on September 15, 2009, at 21:33:29
> forgive my naivete, but i thought since Parnate increases dopamine, it would help combat the RL. maybe my dose (20mg) is too low for much MAO-B inhbition?
But the Seroquel will be occupying the dopamine receptors associated with movement in the substantia nigra and nigrostriatal pathway, particularly at night when you've just taken a dose.
So the dopaminergic effects of the Parnate will be blocked.
Posted by sowhysosad on September 16, 2009, at 11:29:09
In reply to Re: meds + restless leg » sowhysosad, posted by cactus on September 15, 2009, at 22:06:59
> > That's interesting. The soon-to-be-ex Mrs Sad was hitting the antihistamines over the Summer for hay fever which could have made her RLS worse.
>
>
> *if they were sedating ones, then a very big yes*May well have been. I can't remember which one she was taking but I do recall reading it was an SRI.
> Repreve/Requip was fantastic, and it also blew my depression out of the water but it also made me blow chunks so I had to stop after 3 months.
So presumably it must indiscriminately antagonise dopamine receptors? I believe it's pre-synaptic (D1?) receptors that are associated with nausea, not the post-synaptic ones that would be the target of the drug.
Posted by desolationrower on September 16, 2009, at 17:48:25
In reply to Re: meds + restless leg » g_g_g_unit, posted by sowhysosad on September 16, 2009, at 11:23:18
> > forgive my naivete, but i thought since Parnate increases dopamine, it would help combat the RL. maybe my dose (20mg) is too low for much MAO-B inhbition?
>
> But the Seroquel will be occupying the dopamine receptors associated with movement in the substantia nigra and nigrostriatal pathway, particularly at night when you've just taken a dose.
>
> So the dopaminergic effects of the Parnate will be blocked.a2 block increases cortical DA, as does 5ht2 blx. low doses could help, although you could have catecholamine increases while the reeptors are blocked, and i forget what brain region matters for RLS
heres a study availible that shows thing though its not the main point of the study http://www.aapsj.org/view.asp?art=aapsj080226
remember also that quetiapine isn't a strong dA blockers (see also: it sucks for reducing positive symptoms)
-d/r
Posted by cactus on September 16, 2009, at 22:41:42
In reply to Re: meds + restless leg, posted by g_g_g_unit on September 16, 2009, at 2:22:10
> > I've never tried Parnate, but anything that promotes dopamine properties stops my RLS. Ask for some clonazepam instead of seroquel, just 2 weeks worth and see what happens.
>
> i"d rather not end up hooked on clonazepam and then have to withdraw. the idea behind seroquel was that at least it isn't addictive, since i build tolerance to benzos really quickly when trying to sleep on an MAOI
>
>
Fair enough, benzos can be shocking to come off. I'm the opposite to you though. I've tried just about all benzos and the only one that gave me terrible trouble was xanax. I can't tolerate seroquel, I hate all AP's actually, you're brave to put up with it though, RLS drives me literally mad. I hope the Parnate works out for you. C
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