Mental Health Disorders Associated with RLS

In this chapter, we cover the myriad ways that restless legs syndrome (RLS) and psychiatry interface. This particularly relevant because RLS was included as a unique sleep disorder in the recent Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Epidemiological data from both population and clinic-based studies have found a higher incidence of mental illness—particularly depressive and anxiety disorders—among cohorts with RLS. Conversely, preliminary data suggest that individuals with mental illness may have higher rates of RLS as well. We discuss neurobiological parallels between RLS and mental illness that may explain such comorbidity. We also consider the phenomenological overlap between RLS and neurocognitive impairment and attention-deficit/hyperactivity disorder. In general, patients with RLS tend to score higher on neuroticism on personality inventories. Data on whether serotonergic antidepressants worsen or improve RLS symptoms remain conflicting. Bupropion may be ideally suited for comorbid depression and RLS. We discuss the role of neuroleptics, sedative-hypnotics, and mood stabilizers in RLS, and we discuss how to differentiate RLS from neuroleptic-induced akathisia. We also review the psychiatric complications of common RLS treatment. We conclude with a practical approach to managing the often difficult situation of comorbid RLS and mental illness.