Examining Depression with Neurological Disorders

Restless Leg Syndrome and Depression

The lifetime prevalence of depression in people with restless leg syndrome (RLS) ranges between 19% and 35%. The mechanisms underlying this association, however, are unknown.

Researchers from Yale University School of Medicine examined the RLS-depression link to determine to what extent sleep disturbance, periodic limb movements during sleep, and antidepressant medication affect this relationship.

A cross-sectional analysis of 982 men (aged 81 ± 4.5 years) assessed for RLS (International RLS Study Group Scale [IRLSS], range, 0-40) and depression (Geriatric Depression Scale[GDS], range, 0-15) and who underwent actigraphy and polysomnography was performed. The men were divided into three groups: no RLS (n=815), mild RLS (IRLSS≤12, n=85), and moderate-to-severe RLS (IRLSS>12, n=82). Researchers defined depression as GDS≥6. Models were adjusted for age, clinic site, race, education, BMI, personal habits, benzodiazepine/dopaminergic medication use, physical activity, cardiovascular risk factors, and apnea-hypopnea index.

Seventeen percent (n=167) of the men had RLS. After adjustment, depression was found to be significantly associated with moderate-to-severe RLS (approximately one in eight men in this group). The men in the moderate-to-severe group were more likely to be on antidepressants, and had more periodic limb movements during sleep, lower sleep efficacy, and more prolonged sleep latency.

In conclusion, as RLS severity increases, so does likelihood of depression. Sleep disturbance periodic limb movements seem to explain this association.

Reference: Koo BB, et al. The Restless Legs Syndrome - Depression Relationship: Effect Mediation by Disturbed Sleep and Periodic Limb Movements. Poster presentation P1.149, Apr 16, 2016. AAN Annual Meeting, Vancouver, British Columbia.

Depression in the Early Post-Stroke Period

Diagnosis and treatment of depression can improve outcomes of stroke rehabilitation, yet post-stroke depression (PSD) remains an under-addressed consequence of stroke. In a study conducted at Wayne State University, Detroit, MI, researchers sought to determine at what point after a stroke PSD symptoms occur.

Eighty-four patients who had an ischemic stroke agreed to take part in a depression interview. The mean age of the group was 56.9 years and 53.6% were male. The group was followed for 4-6 weeks and researchers administered the Beck depression inventory II. Cognitive versus somatic domains of depression were evaluated.

Ten patients had premorbid depression and eight were taking antidepressants. PSD was found in 38.1% of the patients (n=32). Thirteen patients (15.5%) were mildly depressed (score, 14-19), 11 (13.1%) were moderately depressed (score, 20-28), and 8 (9.5%) were severely depressed (score ≥29). Only four patients denied any features of depression.

The patients were more likely to experience somatic symptoms of depression than cognitive dimensions. Twenty-three patients scored 0 in questions related to cognitive dimensions, but only 5 patients scored 0 for somatic dimensions. Patients most commonly reported “loss of energy” and “feeling of tiredness and fatigue.” “Loss of feeling of pleasure” and “change in sleeping patterns” were also frequent.

Physical symptoms of depression appeared within the first few weeks post stroke. Researchers noted a possible interaction between post-stroke fatigue and PSD. Increased awareness of PSD and timely treatment has the potential to improve post-stroke rehabilitation.

Reference: Bhattacharya P, et al. Physical Consequences of Depression Predominate in the Early Post Stroke Period. Poster presentation P1.220, Apr 16, 2016. AAN Annual Meeting, Vancouver, British Columbia.