Dr. M, Remeron - Restless legs syndrome/akathsia

[AlexanderDenmark]

Dr. Marianco, why does Remeron cause restless leg syndrome and/or akathisia in doses 30 mg+ ?

Myself and others have experienced this on remeron. I thought RLS and aktathisa is caused by low dopamine, usually do to High serotonin. But I thought that Remeron is primarly a NE increasing antidepressant and that it's Serotonin increasing properties are insignicant compared to NE:

[pmgamer18]

You might be better off posting this at Dr. M's new forum.
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I was on Remeron and never had this problem later I did have it but taking ZMA fixed it. All Remeron did for me was I put on 50 lbs. I feel it's some bad crap to take.

Originally Posted by AlexanderDenmark

Dr. Marianco, why does Remeron cause restless leg syndrome and/or akathisia in doses 30 mg+ ?

Myself and others have experienced this on remeron. I thought RLS and aktathisa is caused by low dopamine, usually do to High serotonin. But I thought that Remeron is primarly a NE increasing antidepressant and that it's Serotonin increasing properties are insignicant compared to NE:

[AlexanderDenmark]

ZMA fixed? How odd and interesting. Did you feel that Remeron made you gain weight beceause of increased appetite or did it due it by it self(which ever way it does it).

[HeadDoc]

Originally Posted by AlexanderDenmark

Dr. Marianco, why does Remeron cause restless leg syndrome and/or akathisia in doses 30 mg+ ?

Myself and others have experienced this on remeron. I thought RLS and aktathisa is caused by low dopamine, usually do to High serotonin. But I thought that Remeron is primarly a NE increasing antidepressant and that it's Serotonin increasing properties are insignicant compared to NE:

there seems to be only one or low precentage of akathesia. Restless leg is not mentioned specifically. If dopamine is low in the motor center of the brain than restlessness may occur. High serotonin lowers dopamine. The most common side effects of this medication is increased somnolence and weight gain. However, it has fewer sexual sides than other antidepressants.

[jrbecker]

restless legs syndrome from Remeron (mirtazapine) is most likely related to the alpha-2 adrenergic effects of the drug. Many have reported this issue above 30 mg.

[hardasnails1973]

Low ferritin can also cause restless leg syndrome..

[AlexanderDenmark]

Yes, but if it is only remeron 30 mg that triggers RLS then remeron is probably the culprit. I do have low ferritin though as you know.

what does alpha-2 adrenergic effects mean? increased NE or something else?

[jrbecker]

Yes, blocking alpha-2 adrenoreceptors disinhibits NE and can cause RLS. When I used to take the drug though, I noticed the effects were quite acute (typically within the first couple hours after ingestion) however, it was not a problem thereafter. Interestingly, the 5-HT2a/c antagonistic profile of the drug is actually protective against akathisia/EPS effects.