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Bupropion XL use in comorbidity of depression and restless leg syndrome: a case report

Onur Durmaz, Mehmet Alpay Ateş.

Abstract
Restless leg syndrome (RLS) is a sensorimotor disorder with symptoms including uncomfortable subjective sensations in the legs and the urge to move them. This common disorder affects 10% of the population and may reduce quality of life. The pathophysiology of RLS is not well understood but dysfunction of dopaminergic pathways is the most prominent theory. Antidepressants, especially SSRIs, can aggravate the symptoms of RLS. Here we present a 42 year old woman diagnosed with major depressive disorder and comorbid RLS and who had been treated with paroxetine 20 mg/day for 2 months who benefited from switching to bupropion treatment. In this case the RLS symptoms had existed for approximately 3 years but were milder before paroxetine treatment. The patient met the diagnostic criteria for RLS. We used the International Restless Legs Scale (IRLS) and Montgomery-Asberg Depression Rating Scale (MADRS) to measure the patient’s symptom severity. The severity of her depressive symptoms was similar to baseline despite the two month paroxetine treatment. Due to symptoms of RLS and her ongoing depressive complaints, we decided to switch from paroxetine to bupropion. With 150 mg/day bupropion XL treatment, her RLS symptoms improved substantially at a one month follow-up while her depression severity was not changed significantly. Due to inadequate response for depression, bupropion XL was titrated to 300 mg/day. Her depressive symptoms improved significantly at a further one month follow-up. Comorbidity of RLS and depression was found to be as a frequent occurence reported in the literature. We concluded that bupropion, as a selective noradrenergic-dopaminergic reuptake inhibitor can be a good alternative to the SSRIs for patients, who suffer from both depression and RLS.

Key words: restless legs, depression, bupropion



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