Restless Legs with Antidepressants?
Restless leg syndrome is defined as having following four essential clinical consensus criteria:
- (a) Compelling urge to move the legs with or caused by uncomfortable sensations inside the legs.
- (b) Symptoms begin or worsen with rest or inactivity.
- (c) Symptoms are partially or totally relieved by movement; and
- (d) Symptoms are worse in the evening or at night.
In addition to these four essential criteria, following three criterias can support the RLS diagnosis:
- family history
- response to dopaminergic treatment, and
- presence of periodic leg movements in sleep
Several medications have been implicated in onset of restless leg syndrome, with antidepressants having the most evidence (2).
Answer to the above question: Mirtazapine is known to have the highest risk of RLS (Restless Leg Syndrome) and PLM (Periodic Limb Movements).
INTERESTED IN LEARNING MORE?
Read the following two chapters from our Academy:
- Restless Legs Syndrome/Periodic Limb Movements: Diagnosis & Management.
- Antidepressants & risk of RLS (Restless Leg Syndrome) and PLM (Periodic Limb Movements):
(1) Restless Legs Syndrome/Periodic Limb Movements: Diagnosis & Management
- Diagnosis of RLS
- Laboratory Workup
- Treatment for intermittent RLS
- Treatment for daily RLS
- Treatment for refractory RLS
(2) Antidepressants & risk of RLS (Restless Leg Syndrome) and PLM (Periodic Limb Movements):
- Higher risk antidepressants
- Moderate risk antidepressants
- Lower risk antidepressants
- No risk/preferred antidepressants
References:
- Winkelman, J. Restless Legs Syndrome. History of Neurology: Seminal Citations. Arch Neurol. 1999;56(12):1526-1527.
- Kolla BP, Mansukhani MP, Bostwick JM. The influence of antidepressants on restless legs syndrome and periodic limb movements: A systematic review. Sleep Med Rev. 2018;38:131-140.
- Allen RP, Picchietti DL, Auerbach M, et al. Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report. Sleep Med. 2018;41:27-44. doi:10.1016/j.sleep.2017.11.1126
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