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Depression and RLS: What's the Connection?

Restless Legs Syndrome (RLS) can both mimic depression and contribute to it. And in kids, RLS often looks like—surprise!—ADHD.  Clinical psychologist Dr. Ellen Hendriksen explains the muddy relationship between RLS and other conditions.

By
Ellen Hendriksen, PhD,
November 11, 2013

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Halloween has come and gone, but for approximately 10% of Americans, nighttime creepy-crawlies persist.  The tingly, itchy sensations—mostly between the ankle and the knee—aren’t the creeping of spiders or the fluttering of bats, but rather a neurological disorder called Restless Legs Syndrome, or RLS.  Most of the unpleasant sensations occur in the lower legs, but the arms, torso, and even face may also be affected.  Regardless of the geography, the result can be severe insomnia.

Psychological symptoms are not part of an RLS diagnosis.  But RLS and psychology go together like the creepies and the crawlies.  Here’s how:

Link Between RLS and Depression

As noted by Everyday Einstein, RLS has been a recognized disorder since 1685, when Sir Thomas Willis, an English physician, wrote of patients who could not fall asleep due to “leapings and contractions” in their arms and legs.  Willis wrote that they were so uncomfortable they were “no more able to sleep than if they were in a place of greatest torture.”  More than 300 years later, most sufferers of RLS would probably agree.

Fast forward to the 1800s, when the first overlap of RLS with psychology appears.  Theodor Wittmaack, a German neurologist, called the disorder “anxietas tibiarum,” loosely translated as leg movements combined with anxiety or depression.  Wittmaack hit the restless toenail on the head; this is the essential description of RLS.

Separating RLS from depression can be like trying to unscramble an egg, but it’s important to differentiate.  RLS sufferers misdiagnosed with depression may be prescribed SSRIs like Prozac or Zoloft, which can make the sensations of RLS worse, a phenomenon called "augmentation." House call Doctor wrote about augmentation in her episode in 8 Tips to Treat Restless Legs Syndrome (RLS).

Parsing depression from RLS is difficult because the effects of sleep lost to RLS can mimic depression.  Put the 9* symptoms of depression in a lineup, and 5 are instantly recognizable as problems stemming from lack of sleep.  The culprits include:

  1. depressed or irritable mood
  2. insomnia and/or excessive sleepiness
  3. trouble concentrating
  4. mental and/or physical sluggishness or agitation
  5. fatigue

In the doctor’s office, approximately 40% of individuals with RLS describe the 5 symptoms that look like depression.  Without knowledge of additional RLS symptoms, misdiagnosis is easy.

But sometimes the one-two punch of RLS and depression does strike at once.  Indeed, those with RLS have a 2- to 4-fold risk of developing a depressive disorder than those without RLS.  Often, treatment of RLS will significantly improve the depression, thanks to improved sleep.  If antidepressant medication is needed, non-SSRIs like Wellbutrin or the tricyclics don’t seem to cause the same worsening effects.  As always, talk to your general physician or psychiatrist about any medication regimen.

*The remaining 4 symptoms of depression are 6) lack of interest or enjoyment, 7) significant weight gain or loss, 8) feelings of worthlessness or excessive guilt, and 9) thoughts of suicide or that life is not worth living.

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