Depression in epilepsy: Prevalence, clinical semiology, pathogenic mechanisms, and treatment
Depression in epilepsy: Prevalence, clinical semiology, pathogenic mechanisms, and treatment
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DOI：
10.1016/s0006-3223(03)00469-4
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发表时间：
2003-08-01
影响因子：
10.6
通讯作者：
Kanner, AM
中科院分区：
文献类型：
--
作者：
Kanner, AM
抑郁症是癫痫最常见的共病精神疾病。在基于人群的研究中，其终生患病率估计在 6% 至 30% 之间，在三级中心随访的患者中高达 50%。据估计，自杀风险比一般人群高出 10 倍。尽管没有人质疑癫痫会导致抑郁症的风险，但最近的研究也显示，有抑郁症史的人患癫痫的风险会增加 4 至 6 倍。这些数据表明这两种疾病之间可能存在“双向”关系，或者存在共同的致病机制，在另一种疾病存在的情况下促进一种疾病的发生。癫痫抑郁症的临床表现可能与非癫痫患者相同，可以包括重度抑郁症、双相情感障碍和心境恶劣障碍以及轻度抑郁症。然而，在很大一部分病例中，癫痫抑郁症的临床特征不符合 DSM-IV Axis I 的任何类别。癫痫抑郁症可能是由用于治疗癫痫病的各种抗癫痫药物或手术治疗顽固性癫痫后医源性诱发的。尽管抑郁症的患病率相对较高，但它仍然未被认识和治疗，不幸的是，其治疗是基于经验和不受控制的数据。 (C) 2003 年生物精神病学协会。
Depression is the most frequent comorbid psychiatric disorder in epilepsy. Its lifetime prevalence has been estimated at between 6% and 30% in population-based studies and up to 50% among patients followed in tertiary centers. The risk of suicide has been estimated to be 10 times higher than that in the general population. Although no one questions that epilepsy is a risk for depression, recent studies have also revealed that a history of depression is associated with a 4- to 6-fold greater risk of developing epilepsy. These data suggest either a possible "bi-directional" relationship between these two disorders or the presence of common pathogenic mechanisms that facilitate the occurrence of one in the presence of the other. The clinical presentation of depressive disorders in epilepsy can be identical to that of nonepileptic patients and can include major depression, bipolar and dysthymic disorders, and minor depression. In a significant percentage of cases, however, the clinical features of depression in epilepsy fail to meet any of the DSM-IV Axis I categories. Depression in epilepsy may be iatrogenically induced with various antiepileptic drugs used to treat the seizure disorder or after surgical treatment of intractable epilepsy. Despite its relatively high prevalence, depression remains unrecognized and untreated, and unfortunately its treatment is based on empirical and uncontrolled data. (C) 2003 Society of Biological Psychiatry.