Restless Legs Syndrome - RLS and Depression, Including Suicide
When the nights take the mind with them.
There is a sentence that is almost never spoken in a restless legs consultation: sometimes I don't want to go on. People who see a doctor about their legs talk about tingling, dragging and sleepless nights, not about what years of such nights do to a person. The neurologist asks about the legs, the GP about the mood, and the patient sits in between.
This volume brings the two conditions together. A pooled analysis of 24 studies in 2,039 patients found depressive symptoms in 30 per cent of people with restless legs syndrome. Among 317 psychiatric inpatients, 16.4 per cent had restless legs syndrome, and in 76.9 per cent of them it was diagnosed for the first time. The book explains why most of these figures rest on questionnaires, and which three symptoms do not overlap with plain exhaustion: loss of pleasure and interest, hopelessness and worthlessness, and thoughts of death.
It does not avoid the hardest subject. In an American claims-data analysis of 24,179 people with restless legs syndrome, the risk of suicide or self-harm was 2.66 times higher, and it remained raised after depression, insomnia and other conditions had been accounted for. The book sets this against the absolute numbers, which are small, describes the constellations that deserve particular attention, and gives a chapter of its own to the acute crisis: warning signs, what patients and relatives can do, and where help can be reached around the clock.
The treatment dilemma is where it becomes most practical. In a prospective study of people starting an antidepressant, restless legs appeared or worsened in 9 per cent, and with mirtazapine in 28 per cent. In a randomised trial of 231 patients, effective treatment of the legs lowered the depression score from 18.8 to 8.7 points, against 18.4 to 12.1 under placebo. Hence the order for mild to moderate symptoms: the legs first, then reassess. With severe depression or suicidal thoughts nobody waits.
Further chapters cover the psychiatric side effects of dopamine agonists, iron, the two tested psychotherapeutic programmes, exercise and daily structure, and partnership. The last shows how to raise mood, and the hardest question, with your doctor.
WHAT IS IN THE BOOK
- How common depression in restless legs syndrome really is, and why the figures rest mostly on questionnaires
- Which comes first, the legs or the low mood
- Sleep as the bridge between the two conditions
- Exhausted or depressed: the three symptoms that tell them apart
- What the figures on suicide and self-harm say, and what they do not
- Who is particularly at risk, and what relatives notice first
- When it becomes acute: warning signs and what to do now
- Mortality in restless legs syndrome: what lies behind the findings
- New psychiatric illness, impulse control disorders and withdrawal under dopamine agonists
- Which antidepressants and antipsychotics can worsen the legs
- Akathisia or restless legs: the four differences
- Iron, psychotherapy, exercise and the conversation with your doctor
WHO THIS BOOK IS FOR
For patients whose nights weigh on their mood, for anyone taking or considering an antidepressant, and for relatives worried about someone who has fallen silent. Anyone in an acute crisis will find at the front of the book where immediate help can be reached.
ABOUT THE SERIES
Volume 28 of 52 in the book series on restless legs syndrome, part "RLS with Other Conditions". Every volume can be read on its own. The statements in this volume rest on 148 professional sources, each one listed individually in the reference section.
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