Venlafaxine making me twitchy and restless?

April 27, 2023 6:29 AM

Have been medicated for depression for several years. Big flare-up at the end of last year, which caused a switch from an SSRI to venlafaxine. Increasing the dose seems to be making me twitchy and RLSy - is this plausible, and what's the best strategy to cope?

RLS symptoms only started mid-last year when I was on fluoxetine. It's a bit perplexing because I've been on SSRIs for years, and seems unusual for them to trigger RLS so suddenly after so long, but I'm not an expert. I had an IV iron infusion which provided some relief for a few months.

Subsequently prescribed 400mg gabapentin twice per day for the RLS, which seemed to help. But the depression worsened and my venlafaxine dose was increased from 150mg to 225mg. Unfortunately this has made me twitchy (not like an eyelid twitching - more like big jerks of my arms, legs, torso; like the kind you might get while falling asleep). Really unpleasant, with annoying RLS sensations in my legs basically every day.

Is this likely caused by the venlafaxine? I'm a bit worried that I'm in a spiral, where the venlafaxine causes RLS, then I increase the gabapentin, which (I think) can cause depression, which then means I need to increase the venlafaxine...

What's the best plan of action here? Reduce venlafaxine, combine it with another antidepressant, something else? I know bupropion is meant not to trigger RLS; I wonder if I could 'substitute' some of the venlafaxine for bupropion.

Thanks for your help all...

posted by osmond_nash to Health & Fitness (5 answers total)

I'm on venlafaxine. I did have a twitchy period when I was first starting the med. I was somewhat twitchy during the day, but would toss, turn, and randomly flail or kick at night, which was seriously problematic since I sleep next to my partner. I noticed that it was particularly connected to occasionally forgetting my dose or taking it late. Venlafaxine seems to be extremely unforgiving of not keeping a regular schedule. Even when I did take it on schedule though, I would sometimes have restless nights or mornings where I felt, I guess... jangly? As in, I would have loved to twitch and shake the feeling off, but nothing helped. That went away after about two and a half to three weeks and has only ever reappeared when I miss or am very late with a dose.

I would mention it to your doctor (as I did) and monitor this closely but to my understanding, via my doctor, this is within the normal range of adjustment to this medication. Hang in there.
posted by DirtyOldTown at 7:02 AM on April 27, 2023 [1 favorite]

Venlafaxine made me extremely irritable and sleepy, and while I didn't experience it, my doctor told me that twichiness can restlessness can be side effects.

You probably know this already but because of its extremely short half life, withdrawal kicks in REALLY quickly with Venlafaxine so it's important not to take it even an hour late.

For the same reason, reducing the dosage even a little bit can cause rough withdrawal so don't do that without speaking to your doctor.

Withdrawal symptoms from Venlafaxine incude headaches, brain zaps, irritability, nausea, vomiting.

I was prescribed fluoxetine to combat Venlafaxine withdrawal, and it didn't help at all but I believe it does work for many.
posted by Zumbador at 8:21 AM on April 27, 2023

Oh, also, hormonal changes in mid life can really affect how SSRIs influence you.
posted by Zumbador at 8:23 AM on April 27, 2023 [2 favorites]

I had twitchiness and irritability on venlafaxine. It was so bad that my doc switched me to something else. I would definitely discuss this with your doctor.
posted by goatdog at 10:39 AM on April 27, 2023 [1 favorite]

I gave up venlafaxine within a week because I could not sleep on it. At all. No matter what. Five or six days with zero sleep and I was just DONE.

So yeah, talk to the doc, these reactions are pretty individual sometimes. Or not, and the doc will know what it is and what to do.
posted by humbug at 7:21 PM on April 27, 2023 [1 favorite]