Does Antidepressant Use Increases Risk of Restless Legs Syndrome?

Objective: Restless Legs Syndrome (RLS) is often associated with the use of antidepressants. However there is limited number of research about this association. The aim of this study was to investigate the relationship between antidepressant (AD) use and Restless Legs Syndrome (RLS). Methods: 247 patients diagnosed with depression and anxiety disorders were included in this study. A semi-structured data form was applied to all participants to assess socio-demographic and clinical characteristics. In this form, main four criteria proposed by International Study Group for RLS were used to determine RLS. For differential diagnosis of RLS, researchers interviewed patients who responded positively to all of the four questions. Results: Among patients who are included in the study, 41 (17.3%) patients were diagnosed with RLS. In 35 of these patients (85.4% of the whole group), RLS is found to appear or increase with the use of antidepressants. In patients with the diagnosis of RLS, selective serotonin reuptake inhibitors (SSRI) were the mostly used antidepressant group. Mostly used antidepressants were essitalopram, trazodone and venlafaxine. The evaluation made in the whole group and separately in the male and female groups revealed that use of SSRIs, selective noradrenaline reuptake inhibitors (SNRI) or tricyclic antidepressants (TCA) was not related with RLS. In females, use of trazodone and combined therapy of trazodone and ADs increased the risk of RLS significantly. Discussion: The results of our study suggested that occurrence of RLS is especially common in patients using SSRIs, but use of SSRIs, SNRIs or TCAs were not significant risk factors for the development of RLS. In female patients, use of traodone increased RLS risk, and increased risk was found to be especially associated with combination treatment. In the combination treatment, alterations in the drug metabolism may contribute to the development of RLS with ADs. Also the effect of trazodone and its active metabolite m-chloropiperazine on serotonin may be associated with the increased risk of RLS. An increase in RLS risk should be considered in occasions when clinicians prefer trazodone in combination treatment such as insomnia. (Archives of Neuropsychiatry 2012; 49: 212-217)