Depressive and anxiety disorders in epilepsy: Do they differ in their potential to worsen common antiepileptic drug-related adverse events?
Depressive and anxiety disorders in epilepsy: Do they differ in their potential to worsen common antiepileptic drug-related adverse events?
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DOI：
10.1111/j.1528-1167.2012.03488.x
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发表时间：
2012-06-01
期刊：
影响因子：
5.6
通讯作者：
Meador, Kimford J.
中科院分区：
文献类型：
--
作者：
Kanner, Andres M.;Barry, John J.;Meador, Kimford J.
用途：比较癫痫患者（PWE）中焦虑障碍、重度抑郁发作（MDE）和亚综合征抑郁发作（SSDE）对抗癫痫药物（AED）相关不良事件（AE）的影响。研究方法：该研究包括来自美国五家门诊癫痫诊所的188名连续PWE，所有这些人都接受了结构化访谈（SCID），以根据精神疾病诊断和统计手册第四版文本修订（DSM-IV-TR）标准确定当前和过去的情绪障碍以及其他当前轴I精神病诊断。在Beck抑郁量表-II（BDI-II）总分>12或流行病学抑郁中心（CES-D）> 16（在没有任何DSM诊断的情况下）的患者中诊断为SSDE。使用不良事件特征（AEP）测量AE的存在和严重程度。主要发现：与无症状患者（n = 103）相比，SSDE（n = 26）、仅MDE（n = 10）、仅焦虑症（n = 21）或混合MDE/焦虑症（n = 28）患者的AEP评分显著更高，表明AED相关AE更严重。单变量分析显示，过去6个月内持续癫痫发作和服用抗抑郁药与更严重的AE相关。然而，事后分析表明，这些差异是由抑郁症和/或焦虑症的存在。意义：抑郁症和焦虑症加重AED相关AE，即使表现为亚综合征类型。这些数据表明，在临床实践和AED药物试验中，在解释精神病合并症时必须考虑其存在。
Purpose: To compare the effect of anxiety disorders, major depressive episodes (MDEs), and subsyndromic depressive episodes (SSDEs) on antiepileptic drug (AED)related adverse events (AEs) in persons with epilepsy (PWE). Methods: The study included 188 consecutive PWE from five U.S. outpatient epilepsy clinics, all of whom underwent structured interviews (SCID) to identify current and past mood disorders and other current Axis I psychiatric diagnoses according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria. A diagnosis of SSDE was made in patients with total Beck Depression Inventory-II (BDI-II) scores >12 or the Centers of Epidemiologic Studies-Depression (CES-D) > 16 (in the absence of any DSM diagnosis of mood disorder. The presence and severity of AEs was measured with the Adverse Event Profile (AEP). Key Findings: Compared to asymptomatic patients (n = 103), the AEP scores of patients with SSDE (n = 26), MDE only (n = 10), anxiety disorders only (n = 21), or mixed MDE/anxiety disorders (n = 28) were significantly higher, suggesting more severe AED-related AEs. Univariate analyses revealed that having persistent seizures in the last 6 months and taking antidepressants was associated with more severe AEs. Post hoc analyses, however, showed that these differences were accounted for by the presence of a depressive and/or anxiety disorders. Significance: Depressive and anxiety disorders worsen AED-related AEs even when presenting as a subsyndromic type. These data suggest that the presence of psychiatric comorbidities must be considered in their interpretation, both in clinical practice and AED drug trials.