RLS or just anxiety?

[howbeit-abroad]

I recently went through a period of very bad anxiety. I've had depression in the past, but not much anxiety - but seem to have developed true GAD, which I'm currently getting under control with medication (am switching back to sertraline which has worked very well for me in the past).

During my anxious spells I noticed a strange sensation in my legs. In my journal I would write down that I "had an anxious feeling in my legs" or similar, starting a couple of months ago (a couple of weeks after the onset of the anxiety).

A housemate has RLS, so it was only then that I thought maybe I'd developed it. Symptoms are as expected: strange itching/tingling/tight sensations in the thighs, alleviated by moving them or walking. Much better now than it was a month ago or so when I was on the verge of punching my legs to get them to stop bothering me.

I've not had a formal diagnosis - GP didn't really ask many questions when I said had restless legs... but sent me to get bloods drawn. I'm wondering if this is indeed RLS, and whether I should pursue a formal diagnosis, or is it just some physical manifestation of anxiety?

It almost completely disappears when I'm not anxious, and doesn't seem to affect my sleep at all.

Started iron bisglycinate supplementation this week.

[howbeit-abroad]

Some more context: I'm an early-thirties male in the UK. Ferritin levels in June were low at 25.3ug/mL (reference range 30–400) - I'm vegan(ish) so perhaps not surprising.

[SueJohnson in reply to howbeit-abroad]

Improving your ferritin to 100 or more helps 60% of people with RLS and in some cases completely eliminates their symptoms. You also want to ask for your transferrin saturation (TSAT) numbers. You want your transferrin saturation to be over 20% but less than 45%. If your transferrin saturation is OK, then since your ferritin is less than 75 take your iron tables with 100 mg of vitamin C or some orange juice since that helps its absorption. Take it every other day preferably at night at least 1 hour before a meal or coffee and at least 2 hours after a meal or coffee since iron is absorbed better on an empty stomach. When your ferritin becomes between 75 and 100 or if your transferrin saturation was below 20, you may need an iron infusion since iron isn't absorbed as well above 75. If you take magnesium take it at least 2 hours apart since it interferes with the absorption of iron. Don't take tumeric as it can interfere with the absorption of iron. It takes several months for the iron tablets or iron infusion to slowly raise your ferritin. Ask for a new blood test after after 3 months since you are taking iron tablets or 8 weeks if you later have an iron infusion .

[howbeit-abroad in reply to SueJohnson]

have been taking 70mg ferrous bisglycinate daily - should I reduce to once every two days at the same dose?

[SueJohnson in reply to howbeit-abroad]

You can take it every day as long as it is 24 hours apart. Any sooner than that reduces the amount absorbed.

[SueJohnson]

Basically RLS is diagnosed by the following: All of the following must be true for a diagnosis of RLS: 1) The urge to move the legs and sometimes the arms 2) The onset or worsening of symptoms during periods of inactivity when lying down and sometimes when sitting 3) Symptoms occur or worsen in the evening or bedtime. They are usually dormant in the morning 4) Symptoms get better when walking or stretching as long as it is continued. 5) Can't be explained by another medical or behavioral condition. If it is RLS anxiety can definitely make it worse and you are lucky that sertraline doesn't make your RLS worse as it can for some people. Assuming it is RLS, it doesn't sound like you need any treatment at the present time but unfortunately it will probably get worse as you get older. At that time check back here for advice before taking any medicine. If you want to know more about it, check out the Mayo Clinic Updated Algorithm on RLS which will tell you everything you want to know including about its treatment at Https://mayoclinicproceedings.org/a...

[howbeit-abroad in reply to SueJohnson]

Thanks kindly. The one thing that doesn’t line up is that my symptoms aren’t worse at night - they often start very early in the day, sometimes even shortly after waking if it’s a very anxious day.

[restlessstoz in reply to howbeit-abroad]

You say it's not 'worse at night'. does that mean you don't get it at night or that it's just as bad during the day. If that's the case i.e. bad day and night, then I would suspect as has been suggested that it's due to the medication that it's showing up in the daytime as well.

[howbeit-abroad in reply to restlessstoz]

I mean it’s mostly absent at night and doesn’t cause me problems getting to sleep at all.

[Eryl]

Your symptoms are probably connected as they are all related to the nerves (the brain being a big bunch of nerves and your sensations coming from the nerves in your legs). These days a common cause of nervous problems is inflammation, this inflammation is caused by modern diets containing large amounts of processed foods which raise insulin levels (hence the epidemic in diabetes). Have a look for a video by Georgia Ede called 'Our Descent into Madness: Modern Diets and the Global Mental Health Crisis'. or videos by Dr Chris Palmer. I have completely eliminated my RLS by concentrating on lowering my systemic inflammation, this involves avoiding processed food (including wheat based products and fruit juices) and refined seed oils for cooking (I only use olive oil, coconut oil or animal fat)

[Joolsg]

Sue has given you great information on RLS and it does sound like you have it.

However, you mention medication for GAD and switching back to sertraline.

Most SSRI, SNRI and tricyclical anti depressants trigger RLS in susceptible patients so I'm surprised the sertraline didn't trigger it before now.

However, it could also be triggered by low serum ferritin so do get results of full panel fasting bloods to find out your actual levels and if ferritin is below 100, keep taking the ferrous bisglycinate every other night. Just seen that your ferritin is extremely low! Definitely keep taking the ferrous bisglycinate. You need to raise it above 100, preferably 200.

Hopefully the RLS will settle as your brain iron levels raise. Do not let the doctors prescribe dopamine agonists like Pramipexole or Ropinirole as they are no longer first line treatment because of the very high risk of severe worsening of RLS symptoms (augmentation).

[Josana13 in reply to Joolsg]

Joolsg, Thank you for all the much needed information that you provide to us. What is the first line treatment for RLS?

[Joolsg in reply to Josana13]

Iron therapy ( raising serum.ferritin above 100, preferably 200) & eliminating meds that worsen it ( anti depressants, sedating anti histamines etc). Then if symptoms persist, pregabalin or gabapentin.

Use the Mayo Clinic Algorithm as your reference and show to doctors treating you who may not be up to date on latest research and treatments.

mayoclinicproceedings.org/a...

[Joolsg in reply to Josana13]

Are you completely off the Pramipexole now Josana? Are you on replacement meds and did the doctors tell you your full panel iron results?

[howbeit-abroad in reply to Joolsg]

GP did bloods and said all was normal. But on inspection they didn’t test my ferritin at all (just serum iron, transferrin, and transferrin saturation) - does that make sense?

[howbeit-abroad in reply to howbeit-abroad]

Happy to share numbers if that would be useful. GP also said I could stop iron supplementation - tempted to just continue anyway

[Typicallygaslit]

My own experience of ‘anxiety’ and various scientific and anecdotal hypotheses have postulated that rls can be confounded with anxiety and depression. At 56 I’m finally realising I was never really an anxious person in the true sense (whatever that is, if it even exists). I was just someone with chronic stress and profound rls related neurological disturbances that started in my teens. I also have an experience of agitation in my legs and elsewhere (which I assume you mean when you say anxious sensation). I don’t find the term ‘anxiety’ at all useful as to me it’s nothing but a vague umbrella term that pretends to contain some explanatory power when it really doesn’t. It’s much favoured by doctors who think they are being clever if they use it to explain their patients’ problems. At least in my eyes, it explains nothing at all. On the other hand, neurology is a scientific way of looking at these kinds of issues. Unfortunately I doubt you’ll find anyone who’s willing to compare anxiety with rls but you should definitely pursue a diagnosis of rls if it’s disturbing your sleep.