Bupropion and restless legs syndrome: A randomized controlled trial – Source: Journal of the American Board of Family Medicine, Jul-Aug 2011

[Note: While ‘first-line’ dopamine agonist antidepressants tend to make restless legs symptoms worse, this study suggests bupropion (aka Welbutrin, etc.), an ‘atypical’ antidepressant, does not have a negative effect on physical RLS symptoms, meaning it might be a good choice for those with co-morbid RLS and depression. It may even help overall RLS impact somewhat. To read the full text of this article, go to
http://www.jabfm.org/cgi/reprint/24/4/422]

Introduction: Restless legs syndrome (RLS) is a common neurological disorder affecting 10% of the population. Most antidepressants exacerbate symptoms; however, correlational studies have noted symptom improvement with bupropion.

The purpose of the current study was to examine whether, in a controlled study, bupropion would improve the symptoms of RLS, or at least not exacerbate them.

Methods: This was a double-blinded, randomized controlled trial. Twenty-nine participants with moderate to severe RLS received 150 mg sustained-release bupropion once daily, and 31 control participants received a placebo.

Participants were followed for 6 weeks and completed standardized tools, including the International Restless Legs Syndrome Study Group (IRLSSG) severity scale. Results: The primary outcome was change from baseline in IRLSSG severity score; lower scores were associated with improved symptoms.

At 3 weeks, IRLSSG scores were 10.8 points lower in the bupropion group and 6.0 points lower in the placebo group (P = .016).  [Note: the maximum http://www.rls.org.au/pdf/PKGD6.pdf RLS severity score is 40 points, with 4 possible points for mood disturbances. A reduction of 10 points brings down the overall severity one notch – e.g., from severe to moderate or moderate to mild. Note also that via little-understood mechanisms in the central nervous system, the physiological effect of a placebo may be at least in part real.]

At 6 weeks, IRLSSG scores were 10.4 points lower in the bupropion group and 7.6 points lower in the placebo group (P = .108).

Bupropion was more effective than placebo in the treatment of RLS at 3 weeks; however, this difference was not statistically significant at 6 weeks.

Conclusions: The data from our study suggest that bupropion does not exacerbate the symptoms of RLS and may be a reasonable choice if an antidepressant is needed in individuals with RLS.

Larger studies that include titration [study of effects at different doses] of bupropion should be considered to determine if bupropion is appropriate for primary treatment of RLS, particularly considering the lower cost and favorable side effect profile compared with currently recommended first-line dopamine agonists.

Source: Journal of the American Board of Family Medicine, Jul-Aug 2011;24(4):422-8. PMID 21737767, by Bayard M, Bailey B, Acharya D, Ambreen F, Duggal S, Kaur T, Rahman ZU, Roller K, Tudiver F. Department of Family Medicine, East Tennessee State University, Johnson City, Tennessee, USA. [Email:
mbayard@nmcinc.org]

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