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.
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What Comes First: Chicken, Egg, or RLS?
For a long time, mystery shrouded the order of the RLS-depression relationship. It was unclear whether RLS preceded depression, caused it, or was entirely different from it. In 2012, a study of over 56,000 women offered the first indication that RLS comes first, then depression follows, most likely due to disturbed or lost sleep (see References).
RLS starts deep in the genes. Let’s zoom in on a gene that plays a role in limb development. A 2007 study published in Nature Genetics showed that RLS is associated with variations in this gene, which suggests that RLS may have the workings of a developmental disorder. This and other gene variants that predispose RLS run in families—more than 70% of kids with RLS have at least one parent with RLS as well. However, simply carrying the variants doesn’t guarantee RLS; it just means a greater susceptibility.
Symptoms in Kids: RLS or ADHD?
Among the 2% of kids with RLS, symptoms can do a good impression of ADHD. For unknown reasons, in kids, symptoms often happen during the day, not just at night. Picture a restless child fidgeting at his desk at school. He frequently leaves his seat to walk around, eliciting reprimands from the teacher. He can’t concentrate on his work and seems distracted when he’s supposed to be paying attention. The result looks a lot like ADHD. It may be, but it may not.
To further complicate matters, kids with the double whammy of ADHD and a family history of RLS may be at risk for particularly severe ADHD symptoms. So far, studies have been small, but it is possible that iron deficiency plays a role in the overlap. Consult your doctor, however, before administering iron to kids on your own.
So what can one do to treat RLS? Aside from seeing a physician, who may prescribe medication, here are 8 lifestyle changes you can implement right now to help you rest easier:
8 Ways to Minimize Your RLS Symptoms
- Pain relievers. For very mild symptoms, over-the-counter pain relievers can lessen the sensations. Resist self-medicating with alcohol or over-the-counter sedatives; each one can make RLS worse.
- Iron supplements. Despite the connection between iron deficiency and RLS, consult your doctor before starting an iron supplement regimen or giving iron to kids. If your doctor OKs a supplement, keep it out of reach of children.
- Targeted relaxation. Relax leg muscles by soaking in a warm bath, alternate warm and cool packs, or massage the legs.
- Holistic relaxation. Yoga, meditation, or calming spiritual practices can dissipate the stress that exacerbates RLS.
- Exercise. Moderate, regular exercise is a universal balm. With RLS, avoid working out late in the day or at high intensities, as each may exacerbate symptoms. See also: Get-Fit Guy's 10 Ways to Reduce Symptoms of Restless Legs Syndrome.
- Good sleep habits. A cool, dark, quiet room with no TV or other devices that bleep and bloop is important. If your schedule allows, some people living with RLS recommend a later bedtime and later wakeup time. Others swear by a strict bedtime to ensure enough sleep.
- Lifestyle changes. Experiment with cutting out caffeine, alcohol, and tobacco.
- Distraction. Fancifully called “mental alerting activities” by researchers, individuals with RLS report all manner of productive ways to pass the midnight hours they would rather spend sleeping: remodeling a basement, knitting, composing poetry, writing a novel - you name it.
Despite the increase in middle-of-the-night productivity, if you suffer from RLS, I know you’d much rather be sleeping peacefully, free of “leapings and contractions.” There is not yet a cure for RLS, but with information, support, and patience to discover the treatments—both medical and complementary—that work for you, it is possible to live well with RLS.
Winkelmann, J. et al. (2007). Genome-wide association study of restless legs syndrome identifies common variants in three genomic regions. Nature Genetics, 39, 1000-6.
Konofal, E. et al. (2007). Impact of restless legs syndrome and iron deficiency on attention deficit/hyperactivity disorder in children. Sleep Medicine, 8, 711-715.
Li, Y. et al. (2012). Prospective study of restless legs syndrome and risk of depression in women. American Journal of Epidemiology, 176, 279-88.
Ohayon, M., O’Hara, R., Vitiello, M.V. (2012). Epidemiology of restless legs syndrome: A synthesis of the literature. Sleep Medicine Reviews, 16, 283-295.
Willis, T. (1685). The London Practice of Physick: Or the Whole Practical Part of Physick Contained in the Works of Dr. Willis. London: Bassett and Crooke.
Wittmaak, T. (1861). Pathologie und Therapie des Sensibilitäts-Neurosen. In: T. Wittmaak, Lehrbuch der Nervenkrankheiten, Teil 1: Pathologie und Therapie der sensiblen Neurosen. Leipzig: E. Schäfer.