Restless legs syndrome as side effect of second generation antidepressants

Rottach, Klaus G.; Schaner, Bernhard M.; Kirch, Michael H.; Zivotofsky, Ari Z.; Teufel, Lydia M.; Gallwitz, Thorsten; Messer, Thomas

doi:10.1016/j.jpsychires.2008.02.006

Cited by 217 publications

(103 citation statements)

References 29 publications

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“…This contrasts with other antidepressants, which have been shown to exacerbate symptoms. 7 As such, bupropion should be considered for depressed patients with RLS.…”

Section: Discussionmentioning

confidence: 99%

“…6 In another study, RLS was noted as a possible side effect of the use of fluoxetine, paroxetine, citalopram, sertraline, escitalopram, venlafaxine, duloxetine, and mirtazapine. 7 Finally, in one small case series, patients taking bupropion had improvement of their RLS symptoms. 8 To date, no controlled clinical trials have studied the effect of bupropion on the symptoms of RLS.…”

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confidence: 95%

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Bupropion and Restless Legs Syndrome: A Randomized Controlled Trial

Bayard¹,

Bailey²,

Acharya³

et al. 2011

The Journal of the American Board of Family Medicine

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Introduction:Restless legs syndrome (RLS) is a common neurological disorder affecting 10% of the population. Most antidepressants exacerbate symptoms; however, correlational studies have noted symptom improvement with bupropion. The purpose of the current study was to examine whether, in a controlled study, bupropion would improve the symptoms of RLS, or at least not exacerbate them.Methods: This was a double-blinded, randomized controlled trial. Twenty-nine participants with moderate to severe RLS received 150 mg sustained-release bupropion once daily, and 31 control participants received a placebo. Participants were followed for 6 weeks and completed standardized tools, including the International Restless Legs Syndrome Study Group (IRLSSG) severity scale.Results: The primary outcome was change from baseline in IRLSSG severity score; lower scores were associated with improved symptoms. At 3 weeks, IRLSSG scores were 10.8 points lower in the bupropion group and 6.0 points lower in the placebo group (P ‫؍‬ .016). At 6 weeks, IRLSSG scores were10.4 points lower in the bupropion group and 7.6 points lower in the placebo group (P ‫؍‬ .108). Bupropion was more effective than placebo in the treatment of RLS at 3 weeks; however, this difference was not statistically significant at 6 weeks.Conclusions: The data from our study suggest that bupropion does not exacerbate the symptoms of RLS and may be a reasonable choice if an antidepressant is needed in individuals with RLS. Larger studies that include titration of bupropion should be considered to determine if bupropion is appropriate for primary treatment of RLS, particularly considering the lower cost and favorable side effect profile compared with currently recommended first-line dopamine agonists. (J Am Board Fam Med 2011;24: 422-428.)

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“…This contrasts with other antidepressants, which have been shown to exacerbate symptoms. 7 As such, bupropion should be considered for depressed patients with RLS.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 95%

Bupropion and Restless Legs Syndrome: A Randomized Controlled Trial

Bayard¹,

Bailey²,

Acharya³

et al. 2011

The Journal of the American Board of Family Medicine

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“…56 However, the evidence regarding the association of psychotropic medication to RLS remains inconsistent. For example, while some investigators report SSRIs can precipitate RLS, 57 other studies have documented no association 58 or a reduction in RLS symptoms. 59 Moreover, excluding those on medication for depression or anxiety (which would be expected to capture most psychotropics thought to be linked to RLS 56 ) did not appreciably alter prevalence estimates in this population, and excluding those on medication for any chronic condition yielded only modest reductions in RLS prevalence, suggesting that medications are unlikely to account for the high rates of RLS observed in this population.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Restless Legs Syndrome in an Appalachian Primary Care Population: Prevalence, Demographic and Lifestyle Correlates, and Burden

Innes

Flack

Selfe

et al. 2013

Journal of Clinical Sleep Medicine

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Background: Restless legs syndrome (RLS) is a common and distressing sensorimotor disorder of unknown etiology. While the epidemiology of RLS has been examined in several North American and European studies, research on RLS and RLS burden in poor, rural populations, including those residing in Appalachia, remains sparse. In this study, we investigated RLS prevalence in an Appalachian primary care population and examined the association of RLS to demographic factors, lifestyle characteristics, sleep quality, and mood disorders. Methods: Participants of this anonymous survey study were community-dwelling adults aged ≥ 18 years visiting one of 4 West Virginia primary care clinics. Data gathered included detailed information on sleep patterns, demographic characteristics, lifestyle factors, and health/medical history; the survey also included questions specifi c to RLS diagnosis and severity. Response rates were excellent, with 68% of eligible adults contacted returning completed surveys (N = 1,424/2,087). Pregnant women (N = 65) and those with missing data on key variables (N = 142) were excluded from the analyses. Results: Of the 1,217 participants included in the fi nal analytic sample, 19.6% (18.2% with symptoms at least once/month) met the 4 IRLSSG diagnostic criteria in the absence of positional discomfort or leg cramps; 14.5% reported RLS symptoms at least once/week and 10.1% indicated symptoms ≥ 3×/week. Excluding respondents with diabetes, kidney disease, or anemia

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“…Treatment of concomitant depression with serotonin selective reuptake inhibitors may exacerbate restless leg symptoms. 6 This study by Bayard et al 7 examines this common problem that affects approximately 10% of our patients. It also addresses the quandary practitioners face when treating concomitant depression with an antidepressant.…”

Section: Restless Legs Syndromementioning

confidence: 98%

Guest Family Physician Commentaries

Hamrick

2011

The Journal of the American Board of Family Medicine

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Real-world patients with chronic diseases, including diabetes or hypertension, frequently differ from those in more perfect clinical trial settings. Cummings et al 1 describe an innovative approach to measuring glucose control over time by using statistical calculations to measure the area under the curve (AUC) for fluctuations in glycosylated hemoglobin (HbA1c) from the ideal Յ7% (see Figure 1). Though an observational study such as this over 6 to 10 years is less than an ideal design, it observes patients in their environment, including times of varying adherence to lifestyle changes and medication, and removes the Hawthorne effect (patients do better while being observed during a clinical trial). It may also indirectly measure clinical inertia and the response of the health care system to elevated values.The authors take 10 different perspectives of the HbA1c, ranging from the AUC above HbA1c Ͼ7% over time, to sophisticated statistical analysis including "root mean square." The end point was renal function over time using estimated glomerular filtration rate (eGFR) calculated by the Modification of Diet in Renal Disease equation.A strength of the study is the large number of African-American patients. The more rapid decline in this ethnic group irrespective of sex compared with white patients was striking (Figure 2). Yet the determining factors accounting for 27.3% of the variance in the decrease in renal function over time were age, mean systolic blood pressure, initial HbA1c, initial eGFR, and number of HbA1c measurements, not race or sex. Although various HbA1c measurements accounted for 4.9% of the variance in decline of eGFR, the following 5 measures accounted for 4.5% of the variance: AUC above 7%, AUC approximately 7%, HbA1c decrease, HbA1c standard deviation, and HbA1c root mean square approximately 7%.Although this study has important methodologic limitations, it also has important methodologic value: What do we really know about the importance of fluctuations in HbA1c in routine patient care? and What are the best methods for characterizing this variability? Although other studies have looked at single-point or mean HbA1c measurements, this study has taken numerous statistical approaches to characterize HbA1c variation in routine practice over time and has attempted to relate that variability to an important diabetes endpoint. Though this study suggests a relatively smaller role of HbA1c variability compared with other predictors, it was stimulating to follow the sophisticated thought processes.

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Restless legs syndrome as side effect of second generation antidepressants

Cited by 217 publications

References 29 publications

Bupropion and Restless Legs Syndrome: A Randomized Controlled Trial

Bupropion and Restless Legs Syndrome: A Randomized Controlled Trial

Restless Legs Syndrome in an Appalachian Primary Care Population: Prevalence, Demographic and Lifestyle Correlates, and Burden

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