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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 Fred Potter on September 20, 2001, at 20:33:21
Hello everybody
I'm taking Effexor standard tablets for anxiety and depression. While It seems to work well, I have side effects, the most troublesome is restless legs (arms, shoulders, neck and even head) - not just at night either. I understand that ADs can cause this - I used to find Dothiepin did it when I resumed after accidentally missing a dose. Do others suffer this torment? Does it go away eventually? Is it caused by insufficient dopamine activity? All information gratefully received.
Thanks
Fred
Posted by Janelle on September 20, 2001, at 20:42:06
In reply to Restless legs and Effexor, posted by Fred Potter on September 20, 2001, at 20:33:21
Glad to hear that Effexor standard tablets for are working well for your anxiety and depression. The XR version did not work for me. In fact, one of the side effects I had was RESTLESS LEGS - that is a good way to put it. My legs felt like rubber or twitchy at times. It was all part of a feeling of being overcaffeinated.
I have no idea what causes it, but can tell you from my experience that it DID go away. However, the highest dosage of EffexorXR I could tolerate was 75mg/day. What dose are you on? I have read on here that low doses of Effexor act mainly on Serotonin, mid-range also act on Norepinephrine and action on Dopamine kicks on at high doses.
Posted by Fred Potter on September 20, 2001, at 20:46:00
In reply to Re: Restless legs and Effexor » Fred Potter, posted by Janelle on September 20, 2001, at 20:42:06
Thanks for your quick reply. I've gone up to 112.5 mg per day. It may be this increase that's done it. I look forward to its going away. I suppose if the high doses cause dopamine agonism then this would help to alleviate the condition
Posted by Janelle on September 20, 2001, at 20:59:01
In reply to Re: Restless legs and Effexor, posted by Fred Potter on September 20, 2001, at 20:46:00
I would say (but this is just my humble hunch) that the restless legs, dizzy feelings, etc. are iside effects that WILL PASS as you continue to go up on Effexor steadily (hopefully not too rapidly). It sounds like you may be going even higher which is good if you can tolerate it!
It also sounds like you know something about Dopamine agonism since you said that the high dose, which is when it causes some dopamine agonism would help to alleviate the condition. By the way, EffexorXR is *officially* recognized as being for depression and generalized anxiety (acts on Serotonin and Norepinephrine) -- it was on this very board that I learned that it also acts on Dopamine at high doses!
Posted by Mark H. on September 21, 2001, at 2:18:42
In reply to Restless legs and Effexor, posted by Fred Potter on September 20, 2001, at 20:33:21
Hi Fred,
I have difficulty with that "achy muscles needing to be flexed" feeling even after more than four years on Effexor at 150mg a day. The key for me seems to be taking it early enough in the day (after breakfast) in order for some of it to have worn off by the time I go to bed in the evening. If I don't eat in the morning or otherwise forget to take my dose until 2 or 3 in the afternoon, I'm assured of a night of discomfort, especially in my legs and hands.
Additionally, since I have what's known as "periodic limb movement syndrome," which involves rhythmic movement of my legs and thrashing about with my arms during the night anyway, I take half a clonazepam (0.25mg) each evening. It is the most benign and least habit-forming of the benzodiazepines, and it allows me and my wife to sleep together without my keeping her awake all night.
So, try taking your entire dose for the day at breakfast, and if the problem persists, ask your doctor if it would be appropriate for you to try a small amount of clonazepam at night.
Best of luck,
Mark H.
Posted by SalArmy4me on September 21, 2001, at 2:52:56
In reply to Restless legs and Effexor, posted by Fred Potter on September 20, 2001, at 20:33:21
I found that a little bit of trazodone at night gets rid of the restless legs.
Posted by willow on September 21, 2001, at 11:16:33
In reply to Restless legs and Effexor, posted by Fred Potter on September 20, 2001, at 20:33:21
"Do others suffer this torment? Does it go away eventually? Is it caused by insufficient dopamine activity?"
I've been meaning to write a post concerning my visit to a sleep clinic but was waiting to find a happy ending to my visit. I'll give a quick history. I started with severe fatigue over five years ago, which has been diagnosed as Chronic Fatigue Syndrome. Last fall I started taking effexor, which I've been extremely happy with, but the lack of stamina persisted and muscle stiffness and pain including twitches.
The effexor made the twitching worse and like someone described the constant urge to stretch. I had this before the effexor, but it aggravated the symptoms. So I inquired about a sleep test which the doctor sent me for. Results of the sleep test a diagnosis of moderate to severe periodic limb movements and restless leg syndrome.
My "ferritin" level was tested and it is low. The sleep doctor wants to get it up to a 50. You may want to inquire with your health care provider about your ferritin level. Also, you mentioned dopamine. The first drug I was put on for the RLS was mirapex which is somehow related to dopamine.
The mirapex did wonders for the RLS but unfortunately it undid all the good the effexor was doing, so I was put on sinemet. This didn't help and just gave me bad side-effects. So I tried the mirapex again, and the side-effects came again. Right now I'm trying to get my iron levels up.
Two points I would like to make. First is not to take iron supplements without having your iron tested first. My grandmother had a disorder which caused her body to store and produce excess amounts of iron. This can destroy organs. Second others may have better success with the mirapex. My father has schizophrenia, which I think is somehow related to dopamine. Perhaps for some reason the mirapex affected my thinking in a way it may not affect others?
Whistling Willow
ps having to choose between being able to think or a body that obeys the mind, i've settled for thinking
Posted by dennison on September 21, 2001, at 14:23:30
In reply to Re: Restless legs and Effexor » Fred Potter, posted by SalArmy4me on September 21, 2001, at 2:52:56
> I found that a little bit of trazodone at night gets rid of the restless legs.
HiFred--that would certainlybe my interpretation--restlessness of muscles from dopamine diminution from serotonin overdrive. Serotonin "disinhibits muscle fibers" which causes the twitching which is first level of disinhibtion --- spasms and myoclonus "alternating contraction and relaxation of muscles" --2nd level and muscular stiffness especially in neck is jsy a reflection of the constant muscular tension!!! Even though serotonin doesn't block dopamine receptors like anti-psychotics any time serotonin function is enhanced dopamine function is reciporacally diminished. That's why wellbutrin with it's effects on dopamine is so common used in conjunction with ssri's--to offset this lowering dopamine efficiacy from serotonin enhanced function!!!
Posted by Fred Potter on September 23, 2001, at 17:25:49
In reply to Re: Restless legs and Effexor, posted by dennison on September 21, 2001, at 14:23:30
Thanks for all the helpful comments. It sounds like Wellbutrin might be an idea. Trying a benzo is a bit of a joke. I'd be more likely to get cocaine from the doctors round here. I was recently brought off Xanax in a week by a doctor who seems to think it's both morally and pharmacologically evil.
Posted by SLS on September 24, 2001, at 0:06:33
In reply to Re: Restless legs and Effexor, posted by Fred Potter on September 23, 2001, at 17:25:49
> Thanks for all the helpful comments. It sounds like Wellbutrin might be an idea. Trying a benzo is a bit of a joke. I'd be more likely to get cocaine from the doctors round here. I was recently brought off Xanax in a week by a doctor who seems to think it's both morally and pharmacologically evil.
Hi Fred.If for some reason you decide that you must discontinue Effexor, perhaps desipramine would be the right drug for you. Doxepin and Effexor are both serotonergic. Doxepin and Effexor are also noradrenergic. Of the two, I would suspect that it is the serotonergic component that is contributing most to the leg thing (I'm not completely sure). Perhaps it is the NE reuptake inhibition that is most important for you. Desipramine is usually considered devoid of serotonergic activity. Nortriptyline would also represent an alternative in this scenario. Many people respond much better to one than the other.
If you have already tried this, never mind.
:-)
- Scott
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