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Thread: Sertraline and Restless Legs Syndrome

  1. #1

    Sertraline and Restless Legs Syndrome

    Anyone else get this? I have been on sertraline for a couple of months now and most of the initial side-effects are manageable but I have started to get very restless just after falling asleep and it wakes me up and then I can't easily sleep. Ironically, an orgasm often helps me sleep but that's the other side-effect that still lingers, seriously delayed orgasm!

    I have done a bit of research and it could be related to dopamine levels perhaps... I do find it strange that I can fall asleep fine but then get woken up by a horrible irritable feeling in my legs and lower abdomen. I've asked my Dr for a call to discuss but I wondered if anyone else has experienced this?

    Also, I should type up my positive covid recovery story but that's for another day!

  2. #2
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    Re: Sertraline and Restless Legs Syndrome

    Quote Originally Posted by ShiveringWhippet View Post
    Anyone else get this? I have been on sertraline for a couple of months now and most of the initial side-effects are manageable but I have started to get very restless just after falling asleep and it wakes me up and then I can't easily sleep.
    It is a potential side-effect of many ADs. Magnesium supplements may help. Also ask your GP to test your iron and ferritin levels as low levels may be a factor too.

    Ironically, an orgasm often helps me sleep but that's the other side-effect that still lingers, seriously delayed orgasm!
    That is a more common side-effect and one that tends to be ongoing. Some of the things I mention here may help, however, the NHS restricts what GPs can prescribe so not all the medications mentioned may be available to you.
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  3. #3

    Re: Sertraline and Restless Legs Syndrome

    Quote Originally Posted by panic_down_under View Post
    It is a potential side-effect of many ADs. Magnesium supplements may help. Also ask your GP to test your iron and ferritin levels as low levels may be a factor too.
    Thanks for the pointers, I am due a blood test for B12 as that was low this time last year.

    I'll also look into magnesium. If I'm anything like our house plants, I may need some to balance the calcium in our hard water!


    Quote Originally Posted by panic_down_under View Post
    That is a more common side-effect and one that tends to be ongoing. Some of the things I mention here may help, however, the NHS restricts what GPs can prescribe so not all the medications mentioned may be available to you.
    I am thinking of trying a different SSRI (Fluvoxamine?) or perhaps Vanlafaxine. Lack of sleep seriously affects my depression and anxiety, so I need to get this sorted. I've had a good run since the New Year but I am starting to feel the lack of sleep now. I don't remember getting restless legs when I first started on sertraline but I sure got fidgety and restless in the legs when I contracted covid. OH THE ACHING LEGS!

    Also, not being able to snuggle my wife in bed without fidgeting is taking its toll. I miss quickies too!

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    Re: Sertraline and Restless Legs Syndrome

    Quote Originally Posted by ShiveringWhippet View Post
    I am thinking of trying a different SSRI (Fluvoxamine?) or perhaps Vanlafaxine.
    You're thinking of switching because of the restless legs (RL)?

    Because of the way fluvoxamine is metabolized it can interact with many medications so maybe not the best med if you have other health issues. I'd avoid venlafaxine. Because of its short half-life it can be difficult to discontinue and is sometimes a rough ride at the beginning too. It has no real advantage over other SSRIs (despite the claims it is not a true SNRI). It is as likely to trigger RL as sertraline.

    Lack of sleep seriously affects my depression and anxiety, so I need to get this sorted. I've had a good run since the New Year but I am starting to feel the lack of sleep now.
    Some of the over-the-counter herbal supplements can be effective, if not see your GP as SSRI induced insomnia is quite common. Skip mirtazapine if it's offered as it will likely exacerbate the RL issue. Immediate-release trazodone (Desyrel) is the med of choice for SSRI induced insomnia in many countries, but I believe it can be hard to get a prescription for it in the UK, however, there's no harm in asking (it may also help with the sexual dysfunction). It is unlikely to worsen the RL, nor is the old sedating TCA doxepin, however, I'm not sure if it's still available in the UK.

    I miss quickies too!
    Just as well I am incredibly young, and even more incredibly innocent, or I could be having an attack of the vapours about now!
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  5. #5

    Re: Sertraline and Restless Legs Syndrome

    Quote Originally Posted by panic_down_under View Post
    You're thinking of switching because of the restless legs (RL)?
    Well, lack of sleep generally but also RL specifically. I find it near impossible to get anywhere close to 8 hours of sleep (which is what I needed before the Sertraline), and while waking up at the crack of dawn is not a bad thing in itself, not being able to sleep until 3am means I am burning the candle at both ends and I don't think it is sustainable. I find myself awake but tired too often, and that can effect my mood a lot. I can't get stoned and climax and fall asleep any more, which was my usual remedy for this kind of thing! (I'm generally a light sleeper and have mild obstructive sleep apnoea, my only other notable medical condition apart from occasional migraine).

    Quote Originally Posted by panic_down_under View Post
    Because of the way fluvoxamine is metabolized it can interact with many medications so maybe not the best med if you have other health issues. I'd avoid venlafaxine. Because of its short half-life it can be difficult to discontinue and is sometimes a rough ride at the beginning too. It has no real advantage over other SSRIs (despite the claims it is not a true SNRI). It is as likely to trigger RL as sertraline.

    Some of the over-the-counter herbal supplements can be effective, if not see your GP as SSRI induced insomnia is quite common. Skip mirtazapine if it's offered as it will likely exacerbate the RL issue. Immediate-release trazodone (Desyrel) is the med of choice for SSRI induced insomnia in many countries, but I believe it can be hard to get a prescription for it in the UK, however, there's no harm in asking (it may also help with the sexual dysfunction). It is unlikely to worsen the RL, nor is the old sedating TCA doxepin, however, I'm not sure if it's still available in the UK.
    OK I just had a call with my Dr (literally) and she did indeed recommend trying Mirtazapine as the next candidate, I mentioned your concerns but she seemed to think that increased appetite and weight gain would be the main challenge and seemed pretty convinced that it would help me sleep better. I mentioned Trazodone but she was reluctant to prescribe it. I'll give it Mirtazapine a go for a couple of weeks and see what happens. I understand it can be quite difficult to find the most suitable medication for an individual and their condition, so am prepared to go through the NICE list for a couple more meds, as long as they don't cause me major issues. She also booked me in for blood tests next week to rule out iron deficiency and to check my B12.

    Quote Originally Posted by panic_down_under View Post
    Just as well I am incredibly young, and even more incredibly innocent, or I could be having an attack of the vapours about now!
    Hahaha sorry - I'll try not to pollute your innocent mind with such vulgarities in the future Sadly, I could not locate 'fan in front of the face' emote...

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    Re: Sertraline and Restless Legs Syndrome

    Quote Originally Posted by ShiveringWhippet View Post
    I can't get stoned and climax and fall asleep any more, which was my usual remedy for this kind of thing!
    Stoned as in cannabis? If so, stop. Cannabis, or rather THC, causes DNA fragmentation and then neuron cell deaths in the hippocampi (also amygdalae) which is the physical brain problem that manifests as anxiety and/or depression (Ameri A, 1999; Chan GC, 1998 abstract | full text; Yucel M, 2008; Lorenzetti V, 2016).

    OK I just had a call with my Dr (literally) and she did indeed recommend trying Mirtazapine as the next candidate, I mentioned your concerns but she seemed to think that increased appetite and weight gain would be the main challenge and seemed pretty convinced that it would help me sleep better.
    Mirtazapine has an approximate 30% chance of inducing RLS symptoms; by comparison, paroxetine, sertraline, and other psychiatric medications only have an approximate 5% chance of causing RLS symptoms."
    Managing Restless Leg Syndrome: Current Strategies and Treatment Guidelines

    "The problem is most pronounced with mirtazapine provoking or deteriorating RLS in 28% of patients. By contrast, no case occurred during use of reboxetine. As for the other AD, the rate of newly occurred and deteriorated RLS, ranged from 5% to 10%."
    Restless legs syndrome as side effect of second generation antidepressants

    "Among the various antidepressants, mirtazapine may be associated with higher rates of restless legs syndrome and periodic limb movements.

    ...sedating antidepressants such as trazodone, nefazodone, and doxepin do not seem to aggravate periodic limb movements."

    The influence of antidepressants on restless legs syndrome and periodic limb movements: A systematic review

    but there is always the chance that mirtazapine might anaesthetize you to the extend that you'll sleep through even the most violent jitterbugging.

    I mentioned Trazodone but she was reluctant to prescribe it.
    I don't know why UK GPs have such a problem with trazodone. In much of the rest of the world it is virtually the 'gold-standard' treatment for SSRI/SNRI induced insomnia. :unsure

    "for SSRI-induced insomnia, 78% (264/326) chose adding trazodone."
    The pharmacologic management of SSRI-induced side effects: a survey of psychiatrists
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  7. #7

    Re: Sertraline and Restless Legs Syndrome

    Quote Originally Posted by panic_down_under View Post
    Stoned as in cannabis? If so, stop. Cannabis, or rather THC, causes DNA fragmentation and then neuron cell deaths in the hippocampi (also amygdalae) which is the physical brain problem that manifests as anxiety and/or depression (Ameri A, 1999; Chan GC, 1998 abstract | full text; Yucel M, 2008; Lorenzetti V, 2016).
    No I USED to (for many years) suffer from insomnia, which was helped by getting stoned. And in the worst case, with a bit of post coital dopamine. However, since anxiety/depression manifested itself in my life, I can't stand THC. It makes me panicky. So not been doing that for a couple of years.

    Quote Originally Posted by panic_down_under View Post
    Mirtazapine has an approximate 30% chance of inducing RLS symptoms; by comparison, paroxetine, sertraline, and other psychiatric medications only have an approximate 5% chance of causing RLS symptoms."
    Managing Restless Leg Syndrome: Current Strategies and Treatment Guidelines

    "The problem is most pronounced with mirtazapine provoking or deteriorating RLS in 28% of patients. By contrast, no case occurred during use of reboxetine. As for the other AD, the rate of newly occurred and deteriorated RLS, ranged from 5% to 10%."
    Restless legs syndrome as side effect of second generation antidepressants

    "Among the various antidepressants, mirtazapine may be associated with higher rates of restless legs syndrome and periodic limb movements.

    ...sedating antidepressants such as trazodone, nefazodone, and doxepin do not seem to aggravate periodic limb movements."

    The influence of antidepressants on restless legs syndrome and periodic limb movements: A systematic review

    but there is always the chance that mirtazapine might anaesthetize you to the extend that you'll sleep through even the most violent jitterbugging.
    Yes I read a couple of those while I was researching SSRIs and RLS myself. I am also hoping I am one of those people that just gets knocked out! I'm not really looking forward to finding out though... I don't want to go from awake but tired, to asleep all the time but it sounds like that's going to happen. I've also been prescribed pizotifen for migraine prophylaxis before and that knocked me out too. Made me hella grumpy in the mornings and eat like horse Didn't stop the migraines.



    Quote Originally Posted by panic_down_under View Post
    I don't know why UK GPs have such a problem with trazodone. In much of the rest of the world it is virtually the 'gold-standard' treatment for SSRI/SNRI induced insomnia. :unsure
    "for SSRI-induced insomnia, 78% (264/326) chose adding trazodone."
    The pharmacologic management of SSRI-induced side effects: a survey of psychiatrists
    If it could be used for fun, that'll be it. We like our medicine to make us miserable here

  8. #8

    Re: Sertraline and Restless Legs Syndrome

    Also, another thought. I read about cross-tapering when switching AD/AA meds, and my GP didn't seem concerned about switching because I am on a low dose of Sertraline (50mg daily) but she also didn't advise me to start on a half dose for a few days when she prescribed the Sertraline, I am glad I decided to to that myself though as it was a bit of a bumpy ride! I think I'll try tapering anyway.

    Sometimes I do wonder where doctors get their info from...

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    Re: Sertraline and Restless Legs Syndrome

    Quote Originally Posted by ShiveringWhippet View Post
    I've also been prescribed pizotifen for migraine prophylaxis before and that knocked me out too. Made me hella grumpy in the mornings and eat like horse
    Pizotifen is a fairly potent antihistamine with a longish ~23 hour half-life hence the sedation, carbohydrate cravings and the grumpiness in the morning. Mirtazapine will probably produce similar side-effects and it has an even long half-life.

    If it could be used for fun, that'll be it. We like our medicine to make us miserable here
    If by fun you mean 'high' then no. The usual trazodone dose for insomnia is 25-50 mg and no more than 75mg as it becomes less sedating as the dose increases. The dose range for anxiety and depression is 150-400mg (up to 600mg for inpatients) and few would get a buzz even at 600mg.

    my GP didn't seem concerned about switching because I am on a low dose of Sertraline (50mg daily) but she also didn't advise me to start on a half dose for a few days when she prescribed the Sertraline, I am glad I decided to to that myself though as it was a bit of a bumpy ride! I think I'll try tapering anyway.

    Sometimes I do wonder where doctors get their info from..
    GP actually get relatively training is psychological disorders and their treatment. Many know more about, say, tropical diseases which they may never encounter during their career, whereas probably up to a quarter of the patients in their waiting room have a psych disorder, diagnosed or not.
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