Restless legs syndrome (RLS) and mirtazapine

Posted by rw @rwlovell, Jun 30, 2017

Hi,
I recently started mirtazapine and have had a good initial reaction to the drug – my energy is better, my mood. The one rather major problem is it seems to trigger or exacerbate my RLS. I had been on tramadol (for back pain) about a week before starting mirtazapine and I have read that they can interfere with each other and cause RLS. My question is should I look for another antidepressant or is it possible that this will improve with time. Right now I am awake all night until about 5 AM when I catch a few hours of sleep. It is pretty rough.

Interested in more discussions like this? Go to the Depression & Anxiety group.

Holy smokes?! I just signed up and I couldnt beleive your post!! I have had crps for 10 yrs in all 4 limbs now. A pain speciaoist decided to try this drug. It has been 2 wks now since I stopped. I was on 25mg 2x a day. I have never been through such a living nightmare. The rls led to the worse muscle spasms and dystopia I have ever had. I broke out in blisters. As a matter of fact the one on my thumb got so bad it ate right to the bone!! I became suicidal etc.. Im not a drama quenn either and dont belong on any other crps group. Im just saying. PLEASE DR GOOGLE THE SIDE EFFECTS… Please. Yes I felt happy too and actually lost 5 lbs. 👍lol

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@124811

Holy smokes?! I just signed up and I couldnt beleive your post!! I have had crps for 10 yrs in all 4 limbs now. A pain speciaoist decided to try this drug. It has been 2 wks now since I stopped. I was on 25mg 2x a day. I have never been through such a living nightmare. The rls led to the worse muscle spasms and dystopia I have ever had. I broke out in blisters. As a matter of fact the one on my thumb got so bad it ate right to the bone!! I became suicidal etc.. Im not a drama quenn either and dont belong on any other crps group. Im just saying. PLEASE DR GOOGLE THE SIDE EFFECTS… Please. Yes I felt happy too and actually lost 5 lbs. 👍lol

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HI, @124811 – welcome to Mayo Clinic Connect. Sounds like you had a really tough time on the medication.

Just wanted to clarify: the medication prescribed by the pain specialist was mirtazapine? If so, was it prescribed for depression, or for a different purpose?

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@rwlovell

Thanks for replying! We have talked to the doctor on the phone, but the only advice at this point is: stop taking the new drug for now and go back to your former protocol. I did that last night. Still had the RLS, but maybe not as bad. Still kept me awake until about 4:30 AM. Ugh. I have an appointment on Monday. In the meantime….two more nights to go until then and now without the stronger antidepressant — back to citalaphram.

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In reply to @rwlovell I am new to Mayo Connect so hope I am doing this right. I am on .5 MG of Roprinorol at dinner & 3 MG of Ropriorol at about 8:30p.m. I still have some RLS between dinner & 8:30, but by around 10 p.m. I can't stay awake. Usually sleep until 5 a.m. or so.
Hope that might help you.

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@kittermanr

In reply to @rwlovell I am new to Mayo Connect so hope I am doing this right. I am on .5 MG of Roprinorol at dinner & 3 MG of Ropriorol at about 8:30p.m. I still have some RLS between dinner & 8:30, but by around 10 p.m. I can't stay awake. Usually sleep until 5 a.m. or so.
Hope that might help you.

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Hi, @kittermanr – welcome to Mayo Clinic Connect. Thanks for providing some of your experience with restless legs syndrome (RLS). You are doing this absolutely right.

Before you went on this regimen of .5 mg ropinirole at dinner and 3 mg at about 8:30, what were your RLS symptoms like?

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My symptoms were really bad. Hard to describe, other than I couldn't lie still & I couldn't get to sleep for hours!!! Many nights I would have to get up & walk the floor!!!

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@kitterman- I feel for you. I take requip, 3 pills a night. If I get a breakthrough I'm up all night too. I never get up- I'm too tired. Do you take meds for it?

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I have had restless legs for the past 25 years, and the symptoms seem to progress in terms of worsening symptoms as I get older. I've been the gamut of treatment options, and I've listened to both other people who may or may not have restless legs (some think that because they move their legs often in bed while they are sleeping that is the same as restless legs…I am of the opinion that is not restless legs since I cannot lay in bed and have to get up and walk …. a lot at night). But, I digress – to address your question about the mirtazapine, my doctor at Mayo Sleep Center said the only anti-depressant that does not exacerbate restless legs is Wellbutrin or Buproprion. I switched from Celexa, which was working in regard to depression to Wellbutrin after consulting her on my initial visit, and it did help. Another 'ah ha' moment came for me when I visited with the Fibromyalgia Department at Mayo, and they informed me that the fact that I am sensitive to so many drugs is not at all unusual. In fact, many drugs designed to relax or relief anxiety have the opposite effect for me – they increase my restless leg symptoms x 10 and sometimes for up to 36 hours. Some of those drugs are: Trazadone, Klonopin, Ativan, Compazine, etc. I hope this helps.

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Hi All, I landed here in my quest for information about the correlation between mirtazapine and RLS. The latter had never been an issue for me before starting the mirtazapine. I have been on my current regimine for some time now (over a year) and it hasn't subsided.
For me, taking the med earlier is counter-productive to my sleep. I need to hit that "window" of 20-30 minutes between taking the med and going to bed for optimal sleep.
I wanted to share something that has been helping: I have one of those wedge pillows, and I recently started sleeping with my legs elevated on the wedge…it's really helping! I'm sure there is a solid physiological explanation but I haven't researched it, I'm just relieved to have something that helps.
I do walk regularly. I have a large breed dog (Cane Corso) who needs a lot of exercise, so she makes me get out for an hour or two every day.
Another thing I'm going to try is a weighted blanket. I have one, just have it stowed away somewhere. I love it for other reasons (really does feel like a hug, helps with my anxiety), it's just that my current living situation is temporary and cramped so I have been operating with the basics.
Lastly, my doc is starting me on vistaril PRN today. I have been advised that I can take it every night, once a month, or any frequency in between without concomitant effects.
Just wanted to share my experiences as I continue to find resolution for this most annoying issue, and learn from this community.
V.

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@vhn

Hi All, I landed here in my quest for information about the correlation between mirtazapine and RLS. The latter had never been an issue for me before starting the mirtazapine. I have been on my current regimine for some time now (over a year) and it hasn't subsided.
For me, taking the med earlier is counter-productive to my sleep. I need to hit that "window" of 20-30 minutes between taking the med and going to bed for optimal sleep.
I wanted to share something that has been helping: I have one of those wedge pillows, and I recently started sleeping with my legs elevated on the wedge…it's really helping! I'm sure there is a solid physiological explanation but I haven't researched it, I'm just relieved to have something that helps.
I do walk regularly. I have a large breed dog (Cane Corso) who needs a lot of exercise, so she makes me get out for an hour or two every day.
Another thing I'm going to try is a weighted blanket. I have one, just have it stowed away somewhere. I love it for other reasons (really does feel like a hug, helps with my anxiety), it's just that my current living situation is temporary and cramped so I have been operating with the basics.
Lastly, my doc is starting me on vistaril PRN today. I have been advised that I can take it every night, once a month, or any frequency in between without concomitant effects.
Just wanted to share my experiences as I continue to find resolution for this most annoying issue, and learn from this community.
V.

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Hello @vhn, Welcome to Mayo Clinic Connect. Thank you for sharing your experience with RLS and mirtazapine and tips with what helps you. I also sleep with my legs slightly elevated to help with swelling and circulation problems (lymphedema). Here's some information on the topic – What Are the Benefits of Elevating Your Legs? – https://www.healthline.com/health/elevating-legs

Do you mind sharing what you were searching for when you found Connect?

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@johnbishop

Hello @vhn, Welcome to Mayo Clinic Connect. Thank you for sharing your experience with RLS and mirtazapine and tips with what helps you. I also sleep with my legs slightly elevated to help with swelling and circulation problems (lymphedema). Here's some information on the topic – What Are the Benefits of Elevating Your Legs? – https://www.healthline.com/health/elevating-legs

Do you mind sharing what you were searching for when you found Connect?

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Hi John,

Thank you for the warm welcome and the additional info!

I found Connect simply by Googling "mirtazapine and RLS." I selected the Mayo Connect search result based on my familiarity with the Mayo Clinic's stellar reputation.

Kind Regards,

Vanessa

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@vhn

Hi John,

Thank you for the warm welcome and the additional info!

I found Connect simply by Googling "mirtazapine and RLS." I selected the Mayo Connect search result based on my familiarity with the Mayo Clinic's stellar reputation.

Kind Regards,

Vanessa

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Hello, Vanessa and John. @vhn, @johnbishop. I have severe restless leg syndrome diagnosed at the Mayo Sleep Dept during a sleep study a couple years ago. I've had this issue for years, never addressed. The sleep staff did some bloodwork and found I have a very low ferrous level….iron deficiency, often found with RLS. I take Vitron, iron plus C that helps with absorption. Wow, did that help and make a big difference, i.e. RLS lessened and fatigue and other iron deficiency symptoms improved. Also, I'm taking Requip, dopamine enhancer. Another great find! No more RLS, between the two, the problem is controlled.

AND, side effects from both are good for me! I apparently am benefiting from the improved dopamine. No more tremors, only on first waking and/or when more anxious than normal, feet work better and hurt less, legs aren't feeling like or acting like tree trunks, walk better, stand straighter most of the time. In general, my legs and feet and toes are all improved, and more energy, less anxiety and better outlook on the world.

And, I think I'm better in lots of ways due to the b-pap for severe apnea. Also, Vanessa, I'm using MMJ, 1:1 tincture, at bedtime, for pain and anxiety and sleep….. Helps a bunch!

Since I have reflux and have those wedge pillows under my mattress head, I can't elevate my feet too well! But, do elevate every chance during the day. It's a requirement for me now, for edema and blood flow, neuropathy.

Don't know if you can benefit from any of my experiences and finds, hope so. It's amazing how we help each other. And, you're so right about Mayo. That one dept study re sleep apnea led to diagnosis, treatment and relief from RLS, helps with neuropathy, fatigue and all the other side effects that have made a big difference.
Blessings and may your journey continue to lead to good folks and good progress. elizabeth

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@ess77

Hello, Vanessa and John. @vhn, @johnbishop. I have severe restless leg syndrome diagnosed at the Mayo Sleep Dept during a sleep study a couple years ago. I've had this issue for years, never addressed. The sleep staff did some bloodwork and found I have a very low ferrous level….iron deficiency, often found with RLS. I take Vitron, iron plus C that helps with absorption. Wow, did that help and make a big difference, i.e. RLS lessened and fatigue and other iron deficiency symptoms improved. Also, I'm taking Requip, dopamine enhancer. Another great find! No more RLS, between the two, the problem is controlled.

AND, side effects from both are good for me! I apparently am benefiting from the improved dopamine. No more tremors, only on first waking and/or when more anxious than normal, feet work better and hurt less, legs aren't feeling like or acting like tree trunks, walk better, stand straighter most of the time. In general, my legs and feet and toes are all improved, and more energy, less anxiety and better outlook on the world.

And, I think I'm better in lots of ways due to the b-pap for severe apnea. Also, Vanessa, I'm using MMJ, 1:1 tincture, at bedtime, for pain and anxiety and sleep….. Helps a bunch!

Since I have reflux and have those wedge pillows under my mattress head, I can't elevate my feet too well! But, do elevate every chance during the day. It's a requirement for me now, for edema and blood flow, neuropathy.

Don't know if you can benefit from any of my experiences and finds, hope so. It's amazing how we help each other. And, you're so right about Mayo. That one dept study re sleep apnea led to diagnosis, treatment and relief from RLS, helps with neuropathy, fatigue and all the other side effects that have made a big difference.
Blessings and may your journey continue to lead to good folks and good progress. elizabeth

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Elizabeth,

Thank you for sharing your experiences! I'm actually scheduled for blood work, so the timing is great for me to bring this to my doctors' attention when reviewing the results. My grandmother has had to have blood infusions for iron deficiency. She's nearly 93, but there still is the possibility that there is a genetic component to my RLS experiences beyond aging.

Forgive my ignorance, I'm not familiar with MMJ? Google leads me to believe it is medical marijuana derivatives?

I still have intermittent neuropathy, too, following a MVA. I started on Gabapentin initially to address the neuropathy, without understanding until later that Gaba also helps with anxiety. I continue to take Gabapentin on the regular, and definitely notice if I miss too many doses.

I work in BioPharma, so I'm always intrigued to learn what works AND WHY! LOL

I'm so glad, Elizabeth, that you have found some relief and a proper diagnosis. It's a pleasure to "meet" good folks along the journey. I will keep you posted on my journey to wellness. I wish you continued good health!

Kind Regards,

Vanessa

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