This is a poorly understood and quite often misdiagnosed syndrome.
Did you mention having sleeping problems? Restless leg syndrome is generally though to affect sleep because......your leg is restless.
Here are the symptoms (put together by a panel @ the National Institute of Health):
NIH criteria
In 2003, a National Institutes of Health (NIH) consensus panel modified their criteria to include the following:
(1) an urge to move the limbs with or without sensations
(2) worsening at rest
(3) improvement with activity
(4) worsening in the evening or night
nothing about cramping? Don't factor RLS out just because your definition of cramping may just be their definition of "Urge to move leg"
from here you move on to diagnositics. Heck that what doctors are there to do. Diagnose. Not just throw possiblities at you and then leave you. I hate when doctors do this. It's quite easy to do but it does nothing for the sanity of the patient.
Unfortunately there are no real diagnostic tests for RLS. The doctor assesses the patients history, signs and symptoms whilst asking a series of questions to see if the patient fits the bill so to speak. Were you asked about frequency, duration, and intensity of symptoms as well as their tendency toward daytime sleep patterns and sleepiness, disturbance of sleep, or daytime function? I hate these subjective type diagnostic situations because there could be miscommunication that results in the misdiagnosed, as mentioned above.
Look perhaps I'm playing on this too much. The general approach I use when I am working to resolve an issue is to
(1) diagnose
(2) try and isolate cause
(3) treat cause by removing/avoiding things that aggravate situation or treat by adding things to treat imbalance/change
Chip if you are satisfied with your doctor's diagnosis then I would seek a second opinion. Keep in mind that RLS is difficult to diagnose and if it is RLS then the next doctor may say the same thing of refer you onto a neurologist which usually means lots of money.
Now let's talk about what you believe to be the culprit and match that with what the doctor had to say. You believe that the 5-HTP could possibly be causing the problem, which the doctor says is restless leg syndrome.
5-HTP acts to increase serotonin levels. I've had a read and found this recent study
Biol Psychiatry. 2005 Sep 15;58(6):510-4. Epub 2005 Jul 7.Click here to read Links
Antidepressants and periodic leg movements of sleep.
Yang C, White DP, Winkelman JW.
Sleep Disorders Clinic, Department of Psychiatry, Dong-A University College of Medicine, Busan, Korea. ckyang@daunet.donga.ac.kr
BACKGROUND: Frequent electroencephalographic arousals or awakenings associated with periodic leg movements (PLM) might be responsible in part for the complaints of sleep disturbances made by patients treated with antidepressants. Past studies, however, have determined the effects of only certain limited antidepressants, generally in small numbers of subjects, and never in a head-to-head study. METHODS: A total of 274 consecutive patients taking antidepressants and 69 control subjects not taking antidepressants met criteria among patients referred for overnight diagnostic polysomnography. Periodic leg movements were visually counted and the PLM index (PLMI) was calculated. RESULTS: The venlafaxine and selective serotonin reuptake inhibitor (SSRI) groups had significantly higher mean PLMIs than control and bupropion groups. Periodic leg movement indexes at thresholds considered to be of potential clinical significance were more statistically prevalent in the SSRI and venlafaxine groups compared with the control and bupropion groups. The odds ratio of having a PLMI greater than 20 was 5.15 for the SSRI group and 5.24 for the venlafaxine group compared with the control group. CONCLUSIONS: Venlafaxine and SSRI-induced PLM are likely to be the result of enhanced serotonergic availability and secondarily decreased dopaminergic effects. The results of this study might assist in the selection of antidepressants, especially in patients with pronounced sleep complaints.
PMID: 16005440 [PubMed - indexed for MEDLINE]
So it looks like an increase in serotonin that decreases dopamineric activity would contribute to RLS/PLM. This begs me to ask the question: did you originally choose to start taking 5-HTP because you were feeling a little depressed? Your depression could be related to dopamine. Taking 5-HTP could aggrevate this situation even further. Do the symptoms go away when you stop taking 5-HTP? Funny enough a review I read outlines a number of clinical studies that use dopamine precursors to treat RLS/PLM
M. Grewal, R. Hawa and C. Shapiro, Treatment of periodic limb movements in sleep with selegiline HCl, Mov Disord 17 (2002), pp. 398–401
M.T. De Mello, A.M. Esteves and S. Tufik, Comparison between dopaminergic agents and physical exercise as treatment for periodic limb movements in patients with spinal cord injury, Spinal Cord 42 (2004), pp. 218–221.
and even melatonin gets a mention
D. Kunz and F. Bes, Exogenous melatonin in periodic limb movement disorder: an open clinical trial and a hypothesis, Sleep 24 (2001), pp. 183–187.
Has this at all helped?
I'll try and be as orderly as possible in my following replies--it most likely will be a long post as I can see many ramifications to the above.
As for sleep :
I've just asked my girlfriend about whether I have an agitated/disturbed sleep, as I don't think I do. She backed up that my legs is not restless during my sleep, however she said that I toss and turn a little. I personally think my sleep could use bettering, but overall I'd rate it as being good.
On NIH symptom #1. um, at first thought I'd say it's the legs that I move the most, although I move my hands/arms too. I often feel an urge to scratch this or that part, mostly in the face.
2. Yes, it's worst when I'm reading at the computer desk.
3. After lifting weights, cycling or other sporting activities, I can sit and be more relaxed without any acute urge to move legs or others, but I think this is a normal reaction to physical activities, which is a stress buster.
4. In my case, I think it's worst in the daytime, with no marked increase in the evening, at least if there's any, it's trivial.
While it's crossed my mind, I'd like to bring up that I've recieved two diagnosis of ADHD. The first by Dr. Eric Braverman in NYC 2 years ago, and the second slightly more than a month ago by a local psychiatrist. I brought this up to this PM at the clinic, but she (the attenting M.D.) couldn't find any correlation between the two. While I have not researched this, common sense and my readings on ADHD would have me believe there could be a link, but then, I've not researched this, and cannot make any such assumptions.
Typing this out, my girlfriend is next to me and she agrees I move a lot while sitting at the computer ; sometimes I sit with both legs crossed underneath my body, then switch to only one leg underneath and the next hanging down, then both hanging down and so on and so forth.
I also must tell you that Dr. Braverman in addition to the ADHD diagnosed me with Dysthymia. The local psychiatrist said it was GAD (Generalized Anxiety Disorder). Dysthymia also involves anxiety. I find many of those mental symptoms overlap.
I also agree that it's nothing to help patient's sanity that to throw hypothetical diagnosis such as that thrown at me this PM. I find this careless to some degree. I understand that they prioritize cases according to their seriousness, but still this is not the way I'd like to practice medicine should I were a medical doctor--however they're not their own boss, given I went to the public health service today--in private clinics, things are quite different. Many M.D.'s would like to spend more time with their patients, and provide better care, and around here, that's why they either move to the U.S. where they get a better pay check and work benefits, or go to the private sector.
Were you asked about frequency, duration, and intensity of symptoms as well as their tendency toward daytime sleep patterns and sleepiness, disturbance of sleep, or daytime function?
When I walked into her office, she asked what brought my there, and I started to tell her about what I sensed to be a very mild cramping sensation, and that it comes and goes i.e. like right now, I don't have this, but earlier this evening and today I did, although I had 20 mg 5-HTP after my dinner meal this evening. I don't recall her asking about frequency, but then I'm so talkative that I myself mentioned to her that it comes and goes--someday it's on while on others it's off. I simply have noticed that it seems to fall near those times where I have 5-HTP. I noted this over a 2 months' period. She did ask about intensity, and again I told her that the cramping sensation was mild, although the reslesstless can sometimes get bad, up to a point where carrying out my functions is impaired--most especially when this involves reading from the computer. Reading in a book in the living room for instance doesn't yield as severe symptoms as reading from the computer. I do not have any tendency towards daytime sleep patterns, at least not that I'm aware of. Well, some sleepiness yep, but then I usually get to bed late (around 12 midnight to 1 AM) as I spend much time reading--ironic hey [tung] I think I have decreased productivity big time, as reading through an article which requires about 30 minutes may very well require me an hour and often more than that. Again it's mainly reading from the computer although reading from a book could use some improvement too. I'll soon be getting a brand new computer and and 22'' LCD screen--this time I'll make sure to pick a silent puter case--I don't mind shelling out big bucks, as long as it's as silent as can be. Or I could go the laptop route, which are very quiet. Silence I think would help my computer reading ability, at least I think so, but could find myself to be mistaken in time.
Yes, I took 5HTP to control my anxiety, which in the long run sure adeversly affects mood. So I usually definately have some degree of depression--a retired endocrinology researcher friend of mine recently confirmed this while having a discussion with him.
Your depression could be related to dopamine. Taking 5-HTP could aggrevate this situation even further. Do the symptoms go away when you stop taking 5-HTP? Funny enough a review I read outlines a number of clinical studies that use dopamine precursors to treat RLS/PLM
Two years ago, my libido was down in the dumps--in fact during the last 9 years it was low to non-existent. So two years ago I decided to try Deprenyl after reading much about it. I ordered a pack of Jumex, and started at 2.5 mg twice a week. Each time, what little libido I had prior to taking DPR was annihilated 20 minutes after ingesting the drug. I ran a short DPR course of 3 weeks, during which in the last week I went to to 5 mg 2-3 times that week, to no avail. DPR at this dosage never ever improved my sex drive. I was aware that <10 mg/day DPR is a selective MAO-B inhibitor, so since I'd never gone above 5 mg per day, I felt safe. Seeing that it was helping at the 3 week mark, I decided to stop cold turkey. I should also mention that while I was on DPR, despite seeing no improvement in libido, I felt good and had better focus and attention span. So I was saying that I went off after being on it for 3 weeks, and the next day I had a small piece of dark chocolate at mom's. 20 minutes thereafter, I started having what felt to be extrasystoles. At first I didn't pay much attention thinking this was a random occurence, but I had more of those in the minutes that followed. Then I started feeling a weird panicky feeling started to mount and pervade which I'd never felt before. I started to try and convince myself this would soon go away, but it never did, and 10 minutes later I could feel my heart pounding and my carotid arteries were literally bouncing, and I suddently felt nauseated. I headed straight to the ER, as I'd never ever felt that bad ever. Once at the ER my blood pressure read 185/111 and heart rate about 120 or so. I was having a panic attack. I had 5 more of those until the drug cleared my system I guess. I should also point out that my father had passed away 4 months before this incident, and his passing caused a heck of a lot of grief to me, as we were ever so close and I'm an only child--so I reckon the passing of my beloved father did play a part in the DRP induced panic attacks. Dark chocolate contain PEA and Theobromine IIRC, and DPR IIRC also increase PEA--again IIRC DPR has a second action independent of it's MAO-B inhibition of being a sympatomimetic, and dark chocolate I imagine served as a trigger which spiraled into a full blown panic attack.
I also wish to mention that never ever in my life had I ever came close to anything like those above mentioned panic attacks--it was a first !
Since then, my baseline anxiety is higher, but has recently improved quite a bit through the use of 5HTP. I want to make clear that I not a big proponent of massive doses and never was. I'm rather conservative as far as dosing.
Further, ever since this incident I've had more palpitations, which were checked out twice via wearing a Holter for 48-hour on each occassion. It revealed supraventricular ectopy (extrasystoles) about which I saw 8 M.D.'s all of whom told me this is nothing to worry about. Since anxiety begets/feeds anxiety when I have any I try and disregard them. Also adrenaline acts as a trigger for those, so the less tense I'm the better.
I'm very sleepy now, and will go to sleep, but yes your post was both helpfyl and interesting Zoolander. I thank you for it. You'll probably find this one I've just finished typing out loaded with relevant info, which you didn't know about.
Also normally increasing serotonin lowers dopamine production from dopaminergic neurons since these are joined at the hip. This can lead to increased prolactin, and then lower Gonadotropins, and then lower testosterone, lower dopamine and lower libido. I'm still not clear about whether I'm experiencing low dopamine and/or low serotonin. I'd definately lean more towards serotonin being on the low side, as low serotonin has been linked to panic attacks. If one increases serotonin this leads to a reduction of percieved stress, thus lower Norepinephrine, which might increase dopamine, cause I've read from Dr. Romeo Mariano over at MESO that when there's too much stress the brain lowers dopamine as there's an increase in NE. Dr. Braverman put more emphasis on inhibitory neurotransmitters as well i.e. GABA and serotonin, with some catecholamine support for balance.
Recently, the only things I've been taking on and off are whey protein and 5HTP--I've also added cinnamon to my diet.
P.S. My anxiety is far less now than it used to be.
P.P.S Yesterday I had a large piece of wild pacific ocean salmon (it was luscious for sure) but this morning I woke up with far more anxiety than what I've recently experienced. I think EPA can increase Dopamine IIRC--I read this in Barry Sears's book.
Ok, I'm off to bed now....talk to you later.
