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Seroquel: My Update and PLMS-like side-effect


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Hi all.

I'm a new member with a Background in Behavioral Sciences (may remember 10% of what I'd learned). I've already introduced myself here, so I'll keep the background info short, though of course I would appreciate anyone who should take the time to read my ramblings about me.

Brief Background:

Almost two months ago, in year 10 of my pothededness, I started having irrational fears of NMD-type disease which correlated with terrific anxiety and after a few days of that all-over-light-muscle twitching (which made the anxiety worse). So I went to see a pdoc, and stopped smoking pot.

He put me on Seroquel (I think we've plateaued at 150mg/day), Xanax (from .5 - 1 mg / day to now as needed .125 - .25 mg/day), and lately Inderal (40 mg/day).

At first he thought I should be on Paxil, but I didn't take it. After my neuro gave me a clean bill of health the next week I told him I wasn't having any more Panic Attacks about health, and he agreed no Paxil. He still agreed last visit.

He's been telling me I might have hypomania or slight bipolar-disorder, possibly some ADHD (I dunno about that), and I obviously have some GAD, and possible mild-depression (bummed out about GAD?).

At first I wasn't sure about the BP, but now that I think of it I was a bit over-optimistic about my work in the past, and I've always had issues getting to sleep. I've always felt like I didn't need sleep like other people, like I'm on a 20 hour awake schedule, and I still don't get sleepy, even after taking the Seroquel. I take a pretty hefty 100mg dose before bed, and I can stay awake for hours with no problem anyway.

(EDIT: I realize 100mg isn't 'hefty' for BP. I meant that it is 'hefty'-enough to induce sleep in most people)

Maybe I was self-medicating with weed.

The good news is that I no longer toss and turn at night, and I'm back to being able to sleep 8 hours per night, an ability which I breifly lost until the first few days after seeing my neurologist and having my Xanax cut 3 fold in the same week (which was week 2 of Seroquel).

Anyway, the point of my last few paragraphs is that now I'm realizing that maybe he is onto something... (even though I can tell that > 90% of his patients are people he solicits at the local hospital he works at for Methadone Therapy, and I wonder how much he deals with Anxiety / Depression / BP / Mania).

I feel 95% better than weeks one. The all-over-twitching, which was my biggest anxiety trigger is 95% reduced too, though not gone, even with the Inderal. I didn't expect Inderal to completely eliminate it, so I'm pretty OK with the few remaining twitches in general now.

So What's My Malfunction Now:

In terms of my Mental Health, I still ruminate about illness, I'm still hyper-vigilant for sensations and maybe even somaticize some, and I would say I still have some invasive thoughts about illness, but the affect is much less powerful, and I don't catastrophize my sensations anymore.

I feel almost normal.

There is one thing that I'm wondering about though: My GF told me that last night I was twitching all over in a way that sounded to me like Peripheral Limb Movement Syndrome, and not really at all like the twitching that used to bother me. I don't so much move as contract my muscles. Unlike my wakeful twitches, which felt more like a bubble or flutter in a small area of a muscle that was brief (usually just one contraction, sometimes more) and didn't move the limb, these are repetitive.

My GF said shes seen me do it a few times lately. She says it reminds her of what dogs sometimes do when they 'chase rabbits' in their sleep, and says it moves up my body, starting with my feet, knees, butt/hips, and eventually even shoulders. If she nudges me so that I wake up slightly, it stops.

I did a little research, and it turns out RLS and PLMD are attributed partially to lack of dopamine, and often treated by Dopamine Agonist. In my case, I take Seroquel, a dopamine antagonist, because the pdoc thought I had too much Dopamine kickin'.

As such, I have a nice and neat little theory that this is a Seroquel side-effect, which I will assume is benign unless it starts waking me up consistently.

Does anyone see a problem with my theory? Is this something I should have a health non-neurotic concern over?

By the Way

I've also been taking Kava, Valerian, 5-htp, Meltonin, Mg / Calcium Suppliments, an occasional Multi-Vitamin (4+ weeks), and lately I've started Saint John's Wort (Half doses, 1.5 weeks). I plan on taking Same-E and L-Tryptophan nights for sleep.

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Welcome AnxiouSteve!

Seroquel can cause restless leg syndrome, which may be what you're experiencing.

Pot can make you twitch as well which could be what you were experiencing before.

Has your doctor OK'd your herbal medication regime? That's quite a lot of stuff. There could be some interactions happening but I'm not expert on that.

Before you start taking Sam-E - I have heard that it is not for people with Bipolar as there can be a risk of it inducing mania.

Your Seroquel dose although you describe it as hefty, is actually quite low given you've now been taking it for a while.

Good luck!

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Welcome AnxiouSteve!

Seroquel can cause restless leg syndrome, which may be what you're experiencing.

Pot can make you twitch as well which could be what you were experiencing before.

Pot would give my myclonic jerks when I was awake starting a few weeks before this set in. I ignored them because 'It only happens when I smoke, so what's so bad about that...'

I found out in short order. Anyway I stopped smoking a few weeks ago and have no urge to. I hope to be able to smoke infrequently (once a month maybe) in the distant future, but I'm not gonna chance it any time soon.

I'm pretty sure my all over twitching was caused by some combination of Anxiety, Bad Diet (was Mg deficient), and overall bad lifestyle.

Like I said, it's greatly reduced but not gone. I think the anxiety keeps it alive. If you look at Hypochondria posts on other forums (not sure about this one) you find they are a dime a dozen with twitchers fearing NMD.

Has your doctor OK'd your herbal medication regime? That's quite a lot of stuff. There could be some interactions happening but I'm not expert on that.

I told the pdoc about the Kava, SJW, 5-htp, and the Valerian. He's pretty neutral on the matter.

I know it has been established that SJW reduces the plasma concentrations and half-life of Xanax specifically by 50%, and would have a similar effect on other benzos presumably. I'm willing to take that chance as I don't want to become benzo dependant, anyway. I'm assuming the benefits will outweigh the risk, but just in case I take half of the 2.7mg of Hypercium that is recommended.

However, Seroquel is also metabolized primarily by the same enzyme (CYP3A4), so there is reason to believe it will reduce the effectiveness of that as well. On the other hand both are Psychoactive and affect multiple neurotransmitters so there may be some synergy. I've looked high and low, but I can't find any studies.

It is part of the reason I told the doc I wanted to go from 112.5mg / day to a higher dose. He asked me how high, I suggested 150, and he said 'Sounds good.'

Before you start taking Sam-E - I have heard that it is not for people with Bipolar as there can be a risk of it inducing mania.

If mania is what I had before, I would love to have that back. I haven't started that and I will be sure to look into it and discuss it with my pdoc before I do.

Your Seroquel dose although you describe it as hefty, is actually quite low given you've now been taking it for a while.

Sorry, I forget what topic I was in. You're right: it's low for people with hardcore BP or Schizopphrenia, but I don't know that I have classic BP. I meant it was a hefty dose to induce sleep. I've read of people taking 25mg PM and complaining that they are 'hung over' the next day from it.

I believe I am getting it primarly for Anxiety and/or Depression. I would lean toward possibly having had hypomania, but again I may have been self medicating with a good amount of Pot for the last decade or so, so i guess it remains to be seen what I am really like now.

I felt compelled to edit my initial post to clear that up.

...

Thanks for the response. I'm relieved that you know about the Seroquel RLS connection, and there don't think I should be worried.

There is also a STRONG (~80%) RLS / PLMD correlation, but the thing is I don't have RLS... just the PLMS... Oh well, it sounds like we both think it's from the Seroquel...

Thanks again for the response.

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Wow, you sure know your stuff on the herbal add-ons, it was interesting to read what you posted about the affects of SJW.

And yeah, the delights of mania. I have at times craved that good euphoric mania, but in reality would never want it back. It doesn't come in a package on its own, but instead is combined with too many other bad things... the negative consequences of my out of control elated behaviour, the escalation into dysphoric mania, the sudden slam into crappy mixed states, followed by the plunge into psychotic depression.... suicidality, confusion, hell. I'll leave the mania now thanks ;)

You are right, 100mg is probably a good Seroquel dose for sleep. And I should note that even when I started at 50mg I got the restless leg thing. It went away at higher dose. I believe there are a number of other potential Seroquel side effects that decrease when the dose is upped but others here could probably confirm.

Sounds like you have a good open relationship with your doc to allow you to talk some of this through. And good on you for breaking the dope habit - it is hard to do. I am not sure if I would be advocating occasional smoking but I'm sure you're a grown-up & can make your own decisions :) One thing I would state though is that once the dope has been out of the picture for a while, a true diagnosis is all that more easy to obtain. You're probably nearly there.

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Wow, you sure know your stuff on the herbal add-ons, it was interesting to read what you posted about the affects of SJW.

It's just that researching Mental Health and Legal Drugs is my new hobby. The only thing I know is that SJW induces that enzyme (CYP3A4), meaning it causes your liver to produce more. Over half the drugs in existence are metabolized to some extent or primarily (like Xanax) by that enzyme. If your liver is producing more you will metabolize the drugs faster, presumably reducing their effect.

There are few studies as to how true this is of SJW, but there was the one I cited above for Xanax specifically which seems to confirm some effect.

Now, logic would say you can counteract that by drinking Grapefruit Juice, as GFJ is an inhibitor of the same enzyme, but it doesn't seem to work so easily. I found a study that showed GFJ had no or minimal effect on Xanax metabolism, while it increased blood concentrations of Buspar by 660% after drinking less than a cup... Good thing it's damn near impossible to OD on Buspar.

And yeah, the delights of mania. I have at times craved that good euphoric mania, but in reality would never want it back. It doesn't come in a package on its own, but instead is combined with too many other bad things... the negative consequences of my out of control elated behaviour, the escalation into dysphoric mania, the sudden slam into crappy mixed states, followed by the plunge into psychotic depression.... suicidality, confusion, hell. I'll leave the mania now thanks :)

Sigh... I guess you're right.

And I should note that even when I started at 50mg I got the restless leg thing. It went away at higher dose. I believe there are a number of other potential Seroquel side effects that decrease when the dose is upped but others here could probably confirm.

I did find details about that study by AZ (red flag) which showed that they tested Seroquel for Depression at 150mg and 300mg, with the latter working slightly better than the former, and both being better than placebo. For GAD they did 50 and 150 mg, and got the same result.

I think Anxiety is my main problem, I don't know if it is caused by some flavor of BP or what, though. I'm definitely bummed out about my mental health, but I don't feel severely dysphoric or anything... I dunno if it makes sense to go up to 300 mg, nor if I really want to, but I intend to ask the pdoc what he thinks we should do next time I see him.

Sounds like you have a good open relationship with your doc to allow you to talk some of this through. And good on you for breaking the dope habit - it is hard to do.

You give me too much credit. It becomes easy when every time you get high you experience fantastic Anxiety. Life just employed some Operant Conditioning on my ass, and suddenly I didn't want to smoke anymore...

That said, I do think that not being able to smoke (whether I wanted to or not) was a source of Anxiety in and of itself for the first week or three.... Now I feel liberated to not have to worry about scoring weed anymore.

My pdoc actually wants me to go to NA, but I told him that I refused to re-enact that scene from "Half Baked" with Dave Chapelle and Bob Sagat.

I am not sure if I would be advocating occasional smoking but I'm sure you're a grown-up & can make your own decisions ^_^

You're probably right. I'll may find out around Q3 2009. When I get the results I'll let everyone know. :)

One thing I would state though is that once the dope has been out of the picture for a while, a true diagnosis is all that more easy to obtain. You're probably nearly there.

Here's hoping...

Thanks again for the response.

I know someone who jerks whilst asleep, and when they asked their doctor about it they were told that it was just a normal process for muscles relaxing in some people. I don't know if that is at all pertinent.

Yeah it is pertinent and somewhat normal; common even, as we age. PMLS is a syndrome that becomes a disease (PLMD) when it starts waking you up or causing Divorce. I'm just wondering if I might not have 'Secondary PLMS' (meaning it is caused by something) for some reason other than the Seroquel... That's probably my Health Anxiety talking.

Interestingly, I started getting myclonic jerks last night (which is when you jerk just as you fall asleep and it wakes you), which I hadn't experienced in some time. Sometimes I wonder if I don't have some Somataform Disorder... Seems like a bit of a coincidence that I try to sleep with myclonus on the brain, and suddenly I start getting a new myclonus before I even fall asleep...

At one point I executed a perfect horsekick... The GF was lucky she was on the other side of me at the time, or she would have flown off the bed.

;)

Whatever... I'll just mention it to the pdoc.

Thanks again for the responses

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