Depressed, newly anxious, heartbroken and now restless legs
September 20, 2022 11:32 AM   Subscribe

I’ve had a bit of a nightmare summer mental health-wise. Would appreciate some advice, perspective, and how to move forward.

Back in June I had my first ever serious anxious episode. I have depression and have done for years, but anxiety is only very rarely a feature of it. Suddenly I couldn’t eat, sleep or work and ended up taking a week off (unheard of for me; normally I’m very high-functioning even when mentally unwell).

Still not sure what triggered that episode. There are some candidates:

- I started taking some new meds for my hair (Dutasteride), but only for a couple of weeks, and I’d been taking finasteride up to that point without issue.
- I had a whirlwind romance which broke my heart in a way I haven’t experienced in years, and which caused some disharmony in my houseshare, but again she left a couple of months ago and while I think about her a lot, it’s not crippling.
- I’m also the CTO of a startup I co-founded. I definitely don’t work crazy hours, and I get lots of autonomy, but I feel pressure to perform and there’s a significant key man dependency on me. Is it conceivable I’m just burnt out after “doing 120% for two years” as one of my cofounders put it?

Fast forward to September: I was on fluoxetine 20mg when this all started. That got put up to 40mg, then 60mg (on which I got some but not complete relief); now on sertraline 50mg. I’m keen to up the dose but my GP wants to wait to see if I respond to the low dose; in the past I’ve been prescribed 200mg and responded well and I don’t want to wait months to have to get back to that point. Then again, I wasn’t anxious before. Everything just takes so long.

I also developed restless legs syndrome - truly a horrible illness if you’ve not experienced it. It seemed to come without warning: my journal entries in June/July mention an “anxious feeling in my legs” which I now know to be RLS. Possible the increase in fluoxetine to 40mg caused it, but it’s a new one for me. It seems to be worse when the anxiety is worse, so I’m hoping that treating the anxiety will treat it too.

I’m in the process of getting bloods drawn to see if there’s a physical cause for any of this. Have started iron and vit C for the RLS as that seems to be the go-to treatment. I’m also having weekly therapy sessions, but psych recommended CAT so am looking into that.

So what now?

I’m considering taking some time off work (how long for?) or possibly doing an async thing where I still work but just do the hours where I feel human instead of being online for the whole workday. Cofounders are broadly supportive it seems.

Can you help me think of anything else I should be doing? I feel totally drained by all of this, and robbed of so much time, and ultimately a bit pathetic for this going on so long and so severely limiting my functioning. How can I get some perspective on my situation, and recognise that mental illness isn’t anyone’s fault, that I won’t always be like this, and that recovery is possible?

Thanks so much in advance.
posted by osmond_nash to Health & Fitness (11 answers total) 1 user marked this as a favorite
Response by poster: (Re. heartbreak - I’m referring obliquely to this, but since I wrote that there was a lot of unpleasant stuff that doesn’t get covered)
posted by osmond_nash at 11:35 AM on September 20

yin yoga can help on all of those fronts, including the RLS.

when i get into those mindspaces, working through things in my head never helps, but getting in touch with my body makes a difference every single time.

a couple of links for you -- a longer practice and a shorter one:

a 35 minute yin yoga practice -- no props required
a 10 minute "bedtime" flow (which basically just means very calming and nurturing)
posted by missjenny at 12:03 PM on September 20 [4 favorites]

Pramipexole has been an absolute godsend for my RLS.

Also, fluoxetine made me feel super wired and twitchy. Sertreline was similarly effective for my mental health symptoms (it’s chemically related) but disrupted my sleep less. I still had to be careful with caffeine consumption while I was on it. Not saying you should switch meds if the fluoxetine is otherwise a good fit, but I did want to validate that this may well be a side effect.
posted by theotherdurassister at 12:06 PM on September 20 [1 favorite]

Any of those 3 triggers could cause your symptoms so I wouldn't worry too much about trying to blame one in particular, it was very likely a combination of the three. My worst anxiety/depression period was triggered by a combination of tech-company burnout and social stress. I have symptoms that may or may not be RLS and they seem to come and go in a way that is confusingly linked to my anxiety. Most of the triggers for RLS are also shared with anxiety so it's pretty hard to split it apart. It sounds like you're checking out the obvious physical possibilities which is a good first step.

If your anxiety is the kind that gets worse when you worry about it (mine definitely does), it might help to try and get a prescription for an acute anxiety medicine. I have a prescription for a Beta blocker (metoprolol) that I only take once or twice a week when I need to do something particularly difficult. I also have CBD that I take at night when I can't sleep or when I am having too much body anxiety. These are helpful for their direct effects, but it also makes me less anxious overall because I know I have access to the tools when I really need them. None of the chronic anxiety medications I tried did much of anything for me but everyone is different.

It's a bit hard to know if taking time off will be helpful or not. If you feel very overwhelmed than taking time off to do nothing is perfect, but if you're a goal driven person like me (CTO would indicate that) then you may want to try and work towards something specific. I will say that travel and disrupting routines can be really helpful to get out of an anxiety funk. The brain associates the feeling of anxiety with the environments and situations that were active at the time, and traveling or changing your own environment can lower the strength of that connection.
posted by JZig at 12:17 PM on September 20 [1 favorite]

Response by poster: @theotherdurassister: I think you have it the wrong way round; I switched from fluoxetine to sertraline. Thanks for the tip on pramipexole!
posted by osmond_nash at 1:28 PM on September 20 [1 favorite]

If RLS is keeping me from going to sleep, I stretch my quads and my hamstrings. (Doing these stretches before bed is usually not effective, I don't know why. I have to wait to see if my legs are acting up and then get up and stretch.)

The other thing that works is to sit in lotus (or half lotus, or criss-cross-applesauce, whatever you can do) for 10 minutes before bed.

What I learned from yoga is that I "store a lot of stress" in my hips, which is the hippy-dippy way of saying that stress creates a lot of tension in the kajillion small muscles in and around my pelvis. (And that I burst into tears during deep hip work.)
posted by BrashTech at 3:27 PM on September 20 [1 favorite]

Just coming to suggest magnesium for the RLS. I buy magnesium lotion so I can circumvent the digestive issues. The clinical research into magnesium for RLS is inconclusive overall but anecdotally you'll find a lot of people get relief this way.
posted by crunchy potato at 6:25 PM on September 20 [2 favorites]

I saw your update about the order you tried the meds in, but I think it’s still worth assuming the current one is potentially messing with your sleep. Both meds are more activating/energizing than sedating. One person might have worse side effects with sertreline and another with fluoxetine. It just depends on the individual.
posted by theotherdurassister at 7:38 PM on September 20 [1 favorite]

I have RLS, currently taking setraline 50mg. What works for me to prevent symptoms is:

- keeping my bedroom really cold
- staying well hydrated
- avoiding alcohol completely (one small beer in the evening is enough to cause a problem)
- avoiding antihistamines completely
- lying on an accupressure mat for 20 minutes to help me relax into sleep

Once symptoms have already started, I can sometimes find relief by:

- running both feet under cold water for 30 seconds each
- bringing an ice pack back to the bed with me and keeping my feet on it

The r/RestlessLegs subreddit is a great resource. What works for some can be aggravating for others, and that sub offers many suggestions on what to try next, if a certain remedy or treatment didn't work for you. All the best!
posted by guessthis at 3:47 AM on September 21 [1 favorite]

There is a lot of literature on some of what I will l mention but since I'm not your Dr. I cannot say for sure what is going to work for you or anyone else. I have RLS and have tried a number of things.

What has not helped me:
-hot/cold baths
-stretching, exercise
-iron and B vitamin supplements

What has made mine worse, but I still have RLS even without these:
-antihistamines, like Benadryl (diphenhydramine). These block dopamine receptors and increase RLS.
-Mirtazapine, Prozac, Zoloft. Seratonin bioavailablity can inhibit the function of dopaminergic neurons

What may be making it worse but I haven't removed from my system to check:
-Trintellix, which isn't an SSRI but it does increase serotonergic activity

What has helped:
-Gabapentin. This usually works well but it takes a while, so I take it about 2 hours before bed. It really just relaxes me all over so I fall asleep faster.
-Wellbutrin. This increases dopamine but since it's not really well published as an RLS treatment, I'm not sure what to say about it other than it does help some. I had some left over as a treatment for depression so I've used it but have not received a prescription for RLS. Talk to your Dr!

I'm hesitant try a dopaminergic drug because they carry the risk of augmenting RLS (making it worse!) as well as other side-effects like compulsive behaviors, although they are really the most effective treatment.
posted by waving at 9:49 AM on September 21

Did you have COVID? Restless legs are a thing in Long Covid ( and lots of people have new onset POTS (high postural-related heart rate) that often feels like anxiety until you know what it is.
posted by todolos at 12:44 PM on September 22

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