Magazine article Clinical Psychiatry News

Restless Legs Patients Have High Depression Rate: Both Conditions Have Similar Prevalences, Present with Diurnal Variation, and Tend to Run in Families

Magazine article Clinical Psychiatry News

Restless Legs Patients Have High Depression Rate: Both Conditions Have Similar Prevalences, Present with Diurnal Variation, and Tend to Run in Families

Article excerpt

SANTA ANA PUEBLO, N.M. -- People with restless legs syndrome were three times more likely to have a major depressive disorder in a study of 1,071 Baltimore residents reported by Dr. Hochang Benjamin Lee at the annual meeting of the Academy of Psychosomatic Medicine.

Investigators from Johns Hopkins University in Baltimore found major depressive disorder in 8 of 42 patients (19%) diagnosed with restless legs syndrome (RLS). Only 8.4% of those without RLS met the DSM-IV criteria for depression in diagnostic interviews.

"Depression and anxiety are common in RLS, and vice versa," said Dr. Lee of the Neuropsychiatry and Memory Group at Johns Hopkins. Previous population-based studies suggested a connection, he said, but the new study is "probably the most definitive."

Dr. Lee described numerous overlaps between the two disorders, both of which are diagnosed on the basis of subjective reports from the patient. He said the two conditions have similar prevalence in the community, occur twice as often in women as in men, present with diurnal variation, and tend to run in families. Both also have a high placebo response rate in treatment trials.

Additionally, six of the nine symptoms that the DSM-IV lists for major depressive disorder are common in RLS patients, Dr. Lee said. He cited depressed mood, diminished interest, fatigue or loss of energy, diminished concentration, psychomotor retardation, and insomnia or excessive sleepiness. Indeed, he suggested asking depressed patients who complain of insomnia or excessive sleepiness whether they experience "a creepy crawling feeling" in their legs.

Noting that no guidelines exist for managing depression in RLS patients, Dr. Lee recommended the following strategy:

* If an RLS patient presents with mild depression or dysthymia, treat the RLS first and see whether mood-related symptoms improve. If the patient continues to have depressive symptoms, treat these as well.

* If a severe major depressive disorder occurs along with mild RLS, treat the depression first, preferably with agents that are not SSRIs or tricyclic antidepressants.

* If both RLS and depression are severe, however, consider treating the conditions simultaneously, but avoid using most dopamine agonists for RLS because of the possibility of the rare side effect of psychosis. …

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