"Anxietas Tibiarum": Depression and anxiety disorders in patients with restless legs syndrome

J Neurol (2005) 252 : 6771DOI 10.1007/s00415-005-0604-7 ORIGINAL COMMUNICATIONAnxietas TibiarumJ. WinkelmannM. PragerR. LiebH. PfisterB. SpiegelH.-U. WittchenF. HolsboerC. TrenkwalderA. StrhleDepression and anxiety disorders

in patients with restless legs syndromeReceived: 10 September 2003Received in revised form: 27 May 2004

Accepted: 30 June 2004J. Winkelmann, M.D. M. Prager, M.D. R. Lieb, Ph.D. H. Pfister, Dipl.-Inf. B. Spiegel, Dipl. Soz. H.-U. Wittchen, Ph.D. F. Holsboer, M.D., Ph.D. C. Trenkwalder, M.D. A. Strhle, M.D.

Max Planck Institute of Psychiatry

Munich, GermanyAndreas Strhle, M.D. ()Current address:Dept. of Psychiatry and Psychotherapy

Charit Campus Mitte

Charit University Medicine Berlin

Schumannstr. 20/2110117 Berlin, GermanyTel.: +49-30/450517-034Fax: [phone]E-Mail: [email protected] Abstract Background Symptoms of anxiety and depression in

patients with restless legs syndrome (RLS) have been observed.

However, it is unclear whether rates

of threshold depression and anxiety disorders according to DSM-IV

criteria in such patients are also elevated. Methods 238 RLS patients

were assessed with a standardized

diagnostic interview (Munich-

Composite International Diagnostic Interview for DSM-IV) validated for subjects aged 1865

years. Rates of anxiety and depressive disorders were compared between 130 RLS patients within this

age range and 2265 community respondents from a nationally representative sample with somatic

morbidity of other types. Results

RLS patients revealed an increased

risk of having 12-month anxiety

and depressive disorders with particularly strong associations with

panic disorder (OR = 4.7; 95 %CI = 2.110.1), generalized anxiety

disorder (OR = 3.5; 95 % CI =1.77.1), and major depression

(OR = 2.6; 95 % CI = 1.54.4). In addition, lifetime rates of panic disorder and most depressive disorders

as well as comorbid depression and

anxiety disorders were considerably increased among RLS patients

compared with controls. Conclusions The results suggest that RLS

patients are at increased risk of

having specific anxiety and depressive disorders. Causal attributions

of patients suggest that a considerable proportion of the excess morbidity for depression and panic

disorder might be due to RLS

symptomatology. Key words restless legs

syndrome anxiety depressionIntroductionIn the 19th century Wittmaack first described the co-occurrence of restless legs syndrome (RLS) with symptoms of depression and anxiety and suggested the term

anxietas tibiarum for the condition [29]. He further

proposed the classification of this syndrome as a form of

neurasthenia [13]. Early investigators noted that RLS

occurs particularly in anxious, tense, or depressed patients [6]....