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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by MB on April 23, 2003, at 23:52:02
OK, I've had Restless Leg Syndrome since I was a kid. It's gotten better as I've gotten older, but certain things make it worse. As a kid, any antihistamine drove me over the edge of sanity. As an adult, I have to watch my caffeine intake (though I do rely on it more than a little for amotivation and anhedonia). I've recently re-started an SSRI for depression and Klonopin for anxiety. I told the doc that I had quit the Lexapro I had been on because it gave me such bad RLS that I couldn't take it. He said that Klonopin would alleviate both the subjective feelings of the RLS and my comorbid anxiety, but that Mirapex would actually "correct" the RLS problem on an etiological level. So, now I take all three. Anyway, I'm having a paradoxical reaction to the Mirapex. It is giving me worse restlessness/agitation than any SSRI ever has. And along with the restlessness comes extreme irritibility (sometimes even rage). If I'm not near the tmax of my Klonopin dose when the Mirapex kicks-in, all I can do is curl in a knee-elbow position and rock back and forth, wiggling my feet frenetically (the sensation is so uncomfortable). The doc doubts that this is the Mirapex, but I've tried taking it at different times, and within 2 hours of dosing, I'm always uncomfortable, and within three hours, I'm insanely agitated. The Klonopin mitigates this side effect, and I can only take the Mirapex *at all* after my nighttime K dose is well in effect right before my head hits the pillow (but then my sleep structure is *terrible*). However, on a positive note, I'm waking up in a good mood for the first time since I can remember.
Here's my question regarding the Mirapex: is it possible that I'm not dealing with SSRI-exacerbated RLS, but with Akathisia induced by the SSRI? I always thought they were the same thing (the former being endogenous, and the latter being drug-induced), but I've found a web page claiming otherwise: http://emguidemaps.homestead.com/files/akathisia.html. The web page says that dopamine agonists are magic bullets for RLS, but that they are useless for drug induced akathisia. Is there really a difference, and if so what is it? Plus, "uncontrolled restlessness" was listed as a less common side effect of Mirapex on this web site: http://health.yahoo.com/health/drugs/mir1271/1.html.
Has anyone else on this board had extreme RLS-like symptoms + agitation *BROUGHT ON* by Mirapex?
I like it that the Mirapex allows me to have an orgasm on the Lexapro, and I like waking up in a good mood after only four hours of sleep, but is this worth it?
Since the Klonopin *completely* handles the Lexapro restlessness (until I add the Mirapex), why, I ask myself, am I taking the Mirapex?
Phew, I know this is a long post, but I haven't posted in a long time, and I'm kinda dumping.
Please give me some input, guys and gals,
this is getting frustrating!!MB
Posted by juanantoniod on April 24, 2003, at 1:10:00
In reply to Mirapex--RLS vs. Akathisia? (help!), posted by MB on April 23, 2003, at 23:52:02
For what it's worth, in my experience, RLS has been the least understood and acknowledged of any illness by doctors. Although I cannot help you with your question, I wouldn't believe anything a doctor says about RLS, unless they are an expert in the field. My sleep doc says that Dostinex, a dopamine agonist, can help RLS, but it has to be prescribed off label since it's not approved for that purpose.
Good luck to you,
Antonio
Posted by noa on April 24, 2003, at 5:51:30
In reply to Mirapex--RLS vs. Akathisia? (help!), posted by MB on April 23, 2003, at 23:52:02
This is interesting. I did not have restless legs until I started taking SSRIs and then Effexor. I really don't know if the dx is RLS or akathisia, so your post really interests me.
AD meds cause me to have, when at rest, especially in bed before falling asleep, both myoclonus--invluntary muscle jerks (sometimes my arm would shoot straight up out of the bed!) and "RLS" (I put it in quotations because from your post I am not sure it really is RLS now) which feels to me like an extremely-hard-to-supress urge to move my legs around, kick etc. It is very distressing and prevents sleep completely.
I now take Serzone in addition to Effexor, both for added AD effect, but also to counter the myoclonus and restlessness. It works for the myoclonus, except for a very infrequent minor occurance or two. But it doesn't do much for the feeling of restlessness or the restless legs. So I also take a benzo, and the combo usually works. But I still have the akathisia sometimes, mostly in the day time. Not too bad, just some leg bouncing and fidgetiness. Like right now, I feel the internal sense of restelssness, and I am fidgeting and bouncing my leg as I type. SOmetimes I think it might be when I am not fully alert that my restlessness is worse--like now, since I've just woken up recently and am still yawning. I take adderall xr, but it hasn't kicked in yet.
I have wondered whether to try mirapex. I had taken klonopin, but switched to ativan because the klonopin was lasting too long, making it difficult to get up in the morning.
Thank you for the links--I will read them soon. Thanks for starting this discussion.
Posted by Ritch on April 24, 2003, at 8:10:41
In reply to Mirapex--RLS vs. Akathisia? (help!), posted by MB on April 23, 2003, at 23:52:02
> OK, I've had Restless Leg Syndrome since I was a kid. It's gotten better as I've gotten older, but certain things make it worse. As a kid, any antihistamine drove me over the edge of sanity. As an adult, I have to watch my caffeine intake (though I do rely on it more than a little for amotivation and anhedonia). I've recently re-started an SSRI for depression and Klonopin for anxiety. I told the doc that I had quit the Lexapro I had been on because it gave me such bad RLS that I couldn't take it. He said that Klonopin would alleviate both the subjective feelings of the RLS and my comorbid anxiety, but that Mirapex would actually "correct" the RLS problem on an etiological level. So, now I take all three. Anyway, I'm having a paradoxical reaction to the Mirapex. It is giving me worse restlessness/agitation than any SSRI ever has. And along with the restlessness comes extreme irritibility (sometimes even rage). If I'm not near the tmax of my Klonopin dose when the Mirapex kicks-in, all I can do is curl in a knee-elbow position and rock back and forth, wiggling my feet frenetically (the sensation is so uncomfortable). The doc doubts that this is the Mirapex, but I've tried taking it at different times, and within 2 hours of dosing, I'm always uncomfortable, and within three hours, I'm insanely agitated. The Klonopin mitigates this side effect, and I can only take the Mirapex *at all* after my nighttime K dose is well in effect right before my head hits the pillow (but then my sleep structure is *terrible*). However, on a positive note, I'm waking up in a good mood for the first time since I can remember.
>
> Here's my question regarding the Mirapex: is it possible that I'm not dealing with SSRI-exacerbated RLS, but with Akathisia induced by the SSRI? I always thought they were the same thing (the former being endogenous, and the latter being drug-induced), but I've found a web page claiming otherwise: http://emguidemaps.homestead.com/files/akathisia.html. The web page says that dopamine agonists are magic bullets for RLS, but that they are useless for drug induced akathisia. Is there really a difference, and if so what is it? Plus, "uncontrolled restlessness" was listed as a less common side effect of Mirapex on this web site: http://health.yahoo.com/health/drugs/mir1271/1.html.
>
> Has anyone else on this board had extreme RLS-like symptoms + agitation *BROUGHT ON* by Mirapex?
>
> I like it that the Mirapex allows me to have an orgasm on the Lexapro, and I like waking up in a good mood after only four hours of sleep, but is this worth it?
>
> Since the Klonopin *completely* handles the Lexapro restlessness (until I add the Mirapex), why, I ask myself, am I taking the Mirapex?
>
> Phew, I know this is a long post, but I haven't posted in a long time, and I'm kinda dumping.
>
> Please give me some input, guys and gals,
> this is getting frustrating!!
>
> MB
>
You could try taking a different DA-agonist such as pergolide (Permax) and see if you have the same problems. Mirapex is more of a D3-agonist instead of a D2-agonist. There might be a big difference.I get restlessness on SSRI meds, too. Some more than others. It could be serotonin receptor agonism caused by the SSRI doing that. You might try a little trazodone or serzone or low-dose nortriptyline (5HT-2 antagonist) and see if it goes away.
Posted by judy1 on April 24, 2003, at 22:36:33
In reply to Mirapex--RLS vs. Akathisia? (help!), posted by MB on April 23, 2003, at 23:52:02
I've certainly developed akathisia form a/p's-especially risperdal, and my pdoc says he has had numerous patients develop it from SSRI's- he mentioned paxil and prozac in particular. Your description is pretty classic for akathisia, it is incredibly uncomfortable- I remember pacing all night in a psych ward after 4mg of risperdal, occasionally stopping and doing sit-ups, anything to burn energy. At it's worse it can make a person feel suicidal just to stop the symptoms (been there). I guess I put it in my list of unacceptable side-effects, meaning I won't take a specific drug that causes those symptoms, and have gone to other drugs in the same class that didn't cause it (like seroquel). It really is your decision whether to continue the offending med (and it's easy to figure that out by tapering off and seeing if your symptoms stop)- benefits outweighing any side-effect- it's just that particular one is pretty bad. take care, judy
Posted by Willow on April 24, 2003, at 23:07:49
In reply to Mirapex--RLS vs. Akathisia? (help!), posted by MB on April 23, 2003, at 23:52:02
I had used mirapex for limb movements. It actually initially took the pain out of my legs. I was so happy I increased the doseage to the full tablet like I was instructed. With the increase, I turned into a nut. I would be fine and then the slightest thing could set me off. I really stuggled with the choice of stopping the mirapex, which I finally did. No one could live with me. I tried it again, same problem. So now I take codeine at bedtime.
If the movements just started from taking a medication you may want to wait and see if they subside with time. Whenever my dosage of effexor is increased it becomes worse for awhile. Also letting myself become overtired can make it unbearable. Too much activity during the day can increase the symptoms. They say caffeine will worsen it, but I do use coffee and tea to help me stay awake.
So for myself, it all comes down to making choices.
Whispering Willow
Posted by disney4 on April 28, 2003, at 10:27:54
In reply to Re: Mirapex--RLS vs. Akathisia? (help!) » MB, posted by judy1 on April 24, 2003, at 22:36:33
Just another log or two to add to the fire. I have seen some research that suggests magnesium can help RLS and large doses of vitamin E can help akathisia. I take 500 IU's of vitamin E per day, but they have been working with more than double that for the neuroprotective effects. Just be careful though, because vitamin E can increase the effects of blood thinners.
Posted by nickm on October 24, 2003, at 16:40:22
In reply to Re: Mirapex--RLS vs. Akathisia? (help!), posted by disney4 on April 28, 2003, at 10:27:54
I read in some posts from April, that akathisia and restless legs syndromes could be caused by prozac, effexor, etc., and the person that posted also felt that mirapex .25 mg had begun aggravating the situation.
My wife got akathisia, dysthonia, and EPS from Prozac/Zyprexa in February - May, 2003. Discontinuation of the drugs stopped the involuntary movements.
In August she took Wellbutrin and Abilify, and stopped Wellbutrin in September, but continued taking Abilify, 7.5 mg, until October 12 but the movements were still going on as of October 20th. The last doctor had increased her dose of Klonopin to 4 -5 mg per day, but the Klonopin effect kept lasting less and less.On October 20 a new doctor had her try Benadryl, 100 mg, at bedtime, for she also had insomnia (plus lack of appetite). On October 21, the involuntary movements stopped. She only took 0.5 mg of Klonopin at bedtime.
On October 22nd she had the akathisia return twice during the morning, and afternoon. She needed 0.5 mg of Klonopin on both instances. On the 23rd, the same thing happened. And today, October 24th, she has had three episodes in spite of the Benadryl, and has had to take 0.5 mg of Klonopin three times.
Does anybody know if the akathisia can last as much as 12 days (or more) after stopping the potentially offending drug (Abilify)?
Do the symptoms of akathisia return even while taking an anti-cholinergic like Benadryl, and while not taking any SSRIs (The new doctor took her off Serzone on October 20th to detox, and see how it went until the 27th when she sees him again to then re-evaluate treatments).
Anybody with info on this, please help! We get more confused by the day.
Thanks,
Nickm
Posted by judy1 on October 25, 2003, at 22:36:20
In reply to Can akathisia return after offending drug stopped?, posted by nickm on October 24, 2003, at 16:40:22
My pdoc has told me he had patients that went months before all their symptoms stopped (after stopping the offending med). Personally, mine lasted between 1-2 weeks afterwards. So I guess I wouldn't be too worried after 12 days, and see what the doc has to say on Monday. BTW, I took cogentin for my symptoms.
best of luck, judy
Posted by Nickm on October 29, 2003, at 11:14:55
In reply to Re: Can akathisia return after offending drug stopped? » nickm, posted by judy1 on October 25, 2003, at 22:36:20
> My pdoc has told me he had patients that went months before all their symptoms stopped (after stopping the offending med). Personally, mine lasted between 1-2 weeks afterwards. So I guess I wouldn't be too worried after 12 days, and see what the doc has to say on Monday. BTW, I took cogentin for my symptoms.
> best of luck, judyThanks, Judy. She still has symptoms, but the Benadryl has alleviated them a bit. She also has dysthonia. Her arms become rigid when she walks, and she walks like a robot, as if afraid to...The doctor feels the symptoms will go away as the weeks go by.
It's scary as hell. I picture her the way she was, when she could swing her arms, and walk in carefree frashion, smile openly. I have trouble controlling my own rage at what was done to her by doctors who refused to see the symptoms of akathisia, dysthonia, parkisoninsm being caused by first zyprexa/prozac, and later wellbutrin/abilify.
That doctor, in his own notes, wrote that she had OCD symptoms very somatic, meaning that the akathisia, dysthonia etc that were obvious, he was attributing to OCD...
Wow! Jesus! Talk about inepts, shouldn't-be-practicing quacks. And the trouble is the guy has a reputation for being "an elegant doctor." Maybe it's the way he dresses. He's a quack. I'm glad we found her the new doc.
Nickm
This is the end of the thread.
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