118 Among men, a high depression score was significantly associated with RLS severity. However, such a cross-sectional study cannot determine whether the depression is a consequence of the syndrome or if RLS existed before the RLS appears. In another study, around 45% of

a sample of 218 RLS patients had been diagnosed as having a mood disorder (depression or affective psychosis) in the 5 years prior to the diagnosis of RLS.119 As pointed out by these authors, and illustrated by some case reports,120 it is possible that the sleep complaints of RLS could be incorrectly interpreted as a symptom of depression. However, it is also logical to consider Inhibitors,research,lifescience,medical that discomfort Inhibitors,research,lifescience,medical caused by RLS and the chronic sleep disturbances were triggers for depression, as it has been shown that persons complaining of insomnia have a high risk of developing depression.121,122

In a study evaluating the prevalence and impact of RLS in the general male adult Ruxolitinib cost population, there was a tendency towards reported Inhibitors,research,lifescience,medical isolation related to RLS.123 Subjects with RLS were more likely to report depressed mood (odds ratio [OR] =2.6) and complained more often of reduced libido (OR=2.2). In another recent study, RLS patients had significantly higher depression and anxiety scores measured by the Zung Self-Rating Scales than control subjects and had similar electroencephalographic (EEG) changes to patients with major depression.124 In a population-based, cross-sectional study in adults, utilizing the Hamilton Rating Inhibitors,research,lifescience,medical Scales for Anxiety and Depression, the mean anxiety and depression scores of patients were 8.03 (±6.02) and 9.27 (±5.03), respectively, which were significantly higher than those of the control group.125 Interestingly, these values correlated with the severity score of the RLS, with higher scores correlating with more severe RLS. No data on the temporal relationship of RLS and anxiety/depression symptoms Inhibitors,research,lifescience,medical were provided, and so the causality of this relationship

could not be established. A more recent study attempted to answer this question and added new insights to the relationship between RLS and psychiatric morbidity. In their survey, Winkelmann these et al126 revived the term “anxietas tibiarum” and examined rates of depression and anxiety according to DSM-IV criteria in patients with RLS, compared with a group of controls from a community sample with somatic illness. RLS patients reported higher 12-month rates of any depressive disorder (OR=2.6), panic attacks (OR=2.9), panic disorder (OR=5.2), or generalized anxiety disorder (OR=3.7). RLS patients with depression attributed their sleep disturbances, depressed mood, and reduced interest as being due to their RLS symptoms.