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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by MB on June 26, 2003, at 10:50:57
I've had Restless Leg Syndrome my whole life. I've always been a foot wiggler. The etiology of this is supposed to involve some kind of dysfunction of the dopamine system, I'm told. I think my dopamine system has always been out of whack because I also had really bad tics growing up (eyelid, esophagus and diaphragm tics plus echolalia). Sometimes I wonder if it's because my mom took so much ephedrine while she was pregnant. Well, I'm getting off task, and blaming isn't appropriate...she loved me, and the possible hypoxia from her asthma (had she not taken the ephedrine) could have been even worse for me than the ephedrine, so who am I to judge why things are they way they are.
Anyway...back on task: when I take an antihistamine, withdrawal from caffeine or take an SSRI, I get symptoms that feel EXACTLY like Restless Leg Syndrome but much worse (in my whole body...sometimes I think of topping myself to be rid of the feeling). Since Mirapex is a wonder drug for Restless Leg Syndrome, I was prescribed this to take with my Lexapro. It paradoxically made the drug-exacerbated RLS (akathisia?) worse. It was unbearable.
My question is why would Mirapex be a wonder drug for Restless Leg Syndrom, but not work for akathisia. I've actually read that dopaminergics (levadopa and pergolide, according to this article) are worthless for akathisia: http://www.homestead.com/emguidemaps/files/akathisia.html#akathisia
However, the article also states that unlike Restless Leg Syndrome, with akathisia there is no dysesthesia (pain or uncomfortable sensation). Well, let me tell you that this drug induced restlessness is UNCOMFORTABLE (yes, I'm yelling). Without clonazepam, I'd either quit the med or shove a trocar through my aorta. So, if it's so uncomfortable, does that mean it's *not* akathisia? And if it's *not* akathisia (and, therefore, merely exacerbated RLS), then why did the Mirapex make it so unbearably worse?
What's the consensus here? Is akathisia just a drug induced Restless Leg Syndrome, or do they have two totally different causes (e.g. dopamine deficiencies in different areas)?
MB
Posted by noa on June 26, 2003, at 21:43:12
In reply to Why dopaminergic for RLS but not for akathisia?, posted by MB on June 26, 2003, at 10:50:57
You've posed some great questions, and I look forward to reading responses, too.
Sometimes my akithisia/drug induced restless legs is extremely uncomfortable. I had not thought of it as pain, but I also have muscle aches from the meds and had thought of the akithisa and the muscle pain as separate items. But now I wonder.
Posted by Ritch on June 26, 2003, at 23:22:09
In reply to Why dopaminergic for RLS but not for akathisia?, posted by MB on June 26, 2003, at 10:50:57
> What's the consensus here? Is akathisia just a drug induced Restless Leg Syndrome, or do they have two totally different causes (e.g. dopamine deficiencies in different areas)?
>
> MBI've had "for real" (indisputable) akathisia from antipsychotics (Haldol, esp.) before (that involves the extrapyramidal involuntary muscle stuff), and it is DIFFERENT from the "foot-wiggler" type of RLS that you mention (which I also experience to various degrees along with other family members with and WITHOUT meds being a *cause*). I think RLS and akathisia are two different *symptoms*. They may be connected by some common pathways, but they are different.
Posted by MB on June 27, 2003, at 13:18:06
In reply to Re: Why dopaminergic for RLS but not for akathisia?, posted by noa on June 26, 2003, at 21:43:12
> You've posed some great questions, and I look forward to reading responses, too.
>
> Sometimes my akithisia/drug induced restless legs is extremely uncomfortable. I had not thought of it as pain, but I also have muscle aches from the meds and had thought of the akithisa and the muscle pain as separate items. But now I wonder.
I've never had "pain" with my RLS/akathisia, but sometimes it's worse than pain. I guess the feeling is percieved differently by different people (tingling, crawling, stretching, burning, etc.). Mine happens to feel like ITCHING! I can't bear it. Have you ever had an itch you can't scratch that keeps getting worse? Imagine that under the skin, down deep into the muscles...and the only way to "sctatch the itch" is to move the muscles, wiggle the leg, etc. When I say it's sometimes worse than pain, I'm not exagerating. I've punched my thighs and buttocks with my fist until I bruised just because the severe pain was better than that creeping itch.I've read that antihistamines can exacerbate RLS. When I was about four years old, I had a cold, and my dad gave me an antihistamine. I remember thinking I was going to lose my mind. I started screaming and hitting myself and crying and writhing on the floor. Actually I did lose my mind. I didn't know what was going on, and I was afraid it would last forever. I had never felt someting so horrible. And the *RAGE* associated with it was frightening. I've never felt such pure, blind rage. I haven't had an episode that severe since then, but SSRIs induce the same feeling, just on a lesser scale. Here's my point (yes, there is one): I've read that Benadryl has actually been used successfully to alleviate neuraleptic induced akathisia. I find this strange, because Benadryl (besides knocking me out for 48 hours) makes me wiggle like a worm.
MB
Posted by MB on June 27, 2003, at 13:35:32
In reply to Re: Why dopaminergic for RLS but not for akathisia? » MB, posted by Ritch on June 26, 2003, at 23:22:09
> I've had "for real" (indisputable) akathisia from antipsychotics (Haldol, esp.) before (that involves the extrapyramidal involuntary muscle stuff), and it is DIFFERENT from the "foot-wiggler" type of RLS that you mention (which I also experience to various degrees along with other family members with and WITHOUT meds being a *cause*). I think RLS and akathisia are two different *symptoms*. They may be connected by some common pathways, but they are different.
Can you describe the subjective feeling of the neuroleptic induced akathisia? What was the restlessness *like*? Is it true that there is no dysesthesia with it? Have you ever felt "restless" from an SSRI...if so was it different than the antipsychotic restlessness?Back in my partying days, I remember doing some cocaine and being unable to sit still. I had to keep moving. I had to be doing *something*. If I sat, I'd get horribly anxious so I'd pace, and straighten the books on the shelf, and wipe off the counter top, and walk down the block, etc. *However*, there was no *physical* unpleasantness that kept me moving, it was psychological. I wonder if this is what "for real" akathisia is like.
In the past, you mentioned that Mirapex might not be helping my RLS/(akathisia?) because of it's preference for D3 receptors, and that a dopaminergic with a different ratio of receptor affinity might help. I briefly tried Pergolide years ago, and don't remember it helping much. I started abusing opiates soon after that, and found no use for something as yucky as Pergolide when the lovely (so I thought) opiates did such a better job alleviating the RLS (along with the OCD and the anxiety and the depression). It didn't help me much in the department of setting and achieving life goals, however. I was quite a sloth. But a *content* sloth.
Well, I'm back on the wagon and must fall back on remedies that don't involve breaking the law.
MB
Posted by Ritch on June 27, 2003, at 23:20:51
In reply to Re: Why dopaminergic for RLS but not for akathisia? » Ritch, posted by MB on June 27, 2003, at 13:35:32
> > I've had "for real" (indisputable) akathisia from antipsychotics (Haldol, esp.) before (that involves the extrapyramidal involuntary muscle stuff), and it is DIFFERENT from the "foot-wiggler" type of RLS that you mention (which I also experience to various degrees along with other family members with and WITHOUT meds being a *cause*). I think RLS and akathisia are two different *symptoms*. They may be connected by some common pathways, but they are different.
>
>
> Can you describe the subjective feeling of the neuroleptic induced akathisia? What was the restlessness *like*? Is it true that there is no dysesthesia with it? Have you ever felt "restless" from an SSRI...if so was it different than the antipsychotic restlessness?
The akathisia I got from Haldol happened within an hour of taking it. I couldn't sit still-it wasn't a restlessness while you are sitting kind of thing-it was have to get up and move around constantly with no RELIEF-no matter where I moved to. I remember climbing on top of stuff-cabinets, a stove, all sorts of things trying to alleviate that feeling and it didn't work. UGH, I've never felt anything like it since. I have gotten "shuffles" from SSRI's, but the difference was that moving around constantly made me feel better. I DIDN'T FEEL BETTER with AP-induced akathisia, but HAD TO continue to move regardless-it was torturous. I didn't feel tortured with the SSRI stuff-just felt a need to boogie about and felt good doing it.
>
> Back in my partying days, I remember doing some cocaine and being unable to sit still. I had to keep moving. I had to be doing *something*. If I sat, I'd get horribly anxious so I'd pace, and straighten the books on the shelf, and wipe off the counter top, and walk down the block, etc. *However*, there was no *physical* unpleasantness that kept me moving, it was psychological. I wonder if this is what "for real" akathisia is like.Sounds similar to AP-akathisia in the sense of "horribly anxious".
>
> In the past, you mentioned that Mirapex might not be helping my RLS/(akathisia?) because of it's preference for D3 receptors, and that a dopaminergic with a different ratio of receptor affinity might help. I briefly tried Pergolide years ago, and don't remember it helping much. I started abusing opiates soon after that, and found no use for something as yucky as Pergolide when the lovely (so I thought) opiates did such a better job alleviating the RLS (along with the OCD and the anxiety and the depression). It didn't help me much in the department of setting and achieving life goals, however. I was quite a sloth. But a *content* sloth.
>
> Well, I'm back on the wagon and must fall back on remedies that don't involve breaking the law.
>
> MB
>
I think clonazepam and *avoidance* of meds that *trigger* akathisia would be the first things I could suggest.
Posted by noa on June 27, 2003, at 23:38:56
In reply to Re: Why dopaminergic for RLS but not for akathisia? » MB, posted by Ritch on June 27, 2003, at 23:20:51
The very first time I ever took an antidepressant was kind of like that. I took only a first dose (1/3 of the target dose--I think I took 25 mg) of amytriptaline (sp.?)and had simultaneous hyperactivity/agitation (akithisia?) and extreme sedation. Not a good combo. Couldn't keep my eyes open but couldn't keep still--felt like I was going to jump out of my skin. I had had similar, but milder, reactions to antihistamines before this, but nothing ever quite like this. It was the first and last time I took a TCA. I ended up going to the ER because of how distressing it was. I was so sedated that my speech was slurred and I couldn't walk straight but also totally climbing the walls and jumping out of my skin at the same time.
Sometimes, I get a similar feeling, in a milder form, after I've taken my Serzone and lorazepam, while waiting for the sedating effect to kick in enough to go to sleep. I have the "itchy" resltessness but also the droopy eyelids. It is not pleasant, but since it is short lived until the sedation wins the battle, and it is much milder than what I had with the amytriptaline, I can tolerate it.
Of course, it is now many years later and I am much more used to meds, so that kind of extreme reaction and sensitivity to meds that I had back then probably wouldn't happen anymore.
Posted by MB on June 28, 2003, at 1:54:13
In reply to Re: Why dopaminergic for RLS but not for akathisia?, posted by noa on June 27, 2003, at 23:38:56
> Of course, it is now many years later and I am much more used to meds, so that kind of extreme reaction and sensitivity to meds that I had back then probably wouldn't happen anymore.
Interesting that you say this. I feel the *opposite* way. I feel like the longer I've been on meds, the *more* sensitive to side effects I've become. I wonder if this is because I "know what to look for" as far as side effects go, or if my brain has undergone actual changes from the years on meds that have made me sensitive.
MB
Posted by Ritch on June 28, 2003, at 9:49:41
In reply to Re: Why dopaminergic for RLS but not for akathisia?, posted by noa on June 27, 2003, at 23:38:56
> The very first time I ever took an antidepressant was kind of like that. I took only a first dose (1/3 of the target dose--I think I took 25 mg) of amytriptaline (sp.?)and had simultaneous hyperactivity/agitation (akithisia?) and extreme sedation. Not a good combo. Couldn't keep my eyes open but couldn't keep still--felt like I was going to jump out of my skin. I had had similar, but milder, reactions to antihistamines before this, but nothing ever quite like this. It was the first and last time I took a TCA. I ended up going to the ER because of how distressing it was. I was so sedated that my speech was slurred and I couldn't walk straight but also totally climbing the walls and jumping out of my skin at the same time.
>
> Sometimes, I get a similar feeling, in a milder form, after I've taken my Serzone and lorazepam, while waiting for the sedating effect to kick in enough to go to sleep. I have the "itchy" resltessness but also the droopy eyelids. It is not pleasant, but since it is short lived until the sedation wins the battle, and it is much milder than what I had with the amytriptaline, I can tolerate it.
>
> Of course, it is now many years later and I am much more used to meds, so that kind of extreme reaction and sensitivity to meds that I had back then probably wouldn't happen anymore.
I had a similar reaction to taking Remeron. I don't like the feeling of being heavily sedated. Also experienced an inner raciness-restlessness at the same time which aggravated the heck out of me. I was hoping the "fog" would dissappear, but it didn't. I had the WILL to start all sorts of projects, but the old bod just wouldn't comply with all of the demands. I think avoiding noradrenergic meds that also sedate would be best. WB was different-I was restless AND had the energy to work on several projects. That stuff wore me out totally.
This is the end of the thread.
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