How do you counsel patients with isolated REM behavioral sleep disorder secondary to antidepressant on the risk of developing a neurodegenerative disease?

If I believe the RBD is truly secondary to antidepressant use, then the risk of developing an alpha synucleinopathy should be very low. However, this may not be able to be clearly discerned. In which case, I believe the patient has the right to know and should know about the risk of developing an alpha-synucleinopathy if the RBD is not due to the antidepressant.

I start by reviewing the different causes of RBD. With isolated RBD (iRBD), there is a risk of neurodegeneration over several years, but if it is truly antidepressant induced RBD, the risk is not clear. There have been cases of neurodegenerative disease but it does not appear that the risk is the same as with iRBD. I always initiate risk disclosure but getting consent to review more information. I mention that the isolated form can be associated with the future risk of health issues. If there is diagnostic uncertainty, I also mention that as well, and that I am not sure if they have iRBD.

If they want to know more about the risk, I provide information about the risk, but also highlight the diagnostic uncertainty. This can help with consider...