Paciello N, Mazza M, Mazza S
Centro epilessia, Istituto di Neurologia, Università Cattolica del Sacro Cuore, L.go A. Gemelli, 8, 00168, Rome, Italia.
Clin Ter. 2002 Nov-Dec;153(6):397-402.
An occurrence of depression or depressive symptomatology has been reported in 30% of patients with epilepsy. Depression has been reported peri- and interictally. To make a differentiation may be difficult in patients with frequent seizures. However, complex partial seizures, particularly if are located on temporal lobe, appear to be etiologic factors, especially in men with left-sided epileptic foci. Depression is also more frequent in patients treated with polytherapy, particularly with phenobarbital and vigabatrin. The depression appears to be endogenous and has also been described in patients with temporal lobectomy. Underlying risk factors (genetic, metabolic, etc) and some psychosocial condition also play a part and may explain the increased rates of depression in patients with epilepsy. Treatment approaches include psychotherapy, rationalization of antiepileptic drug medication and antidepressant treatment. The use of antidepressant treatment, in these patients, still raises uncertainties because of the widespread persuasion that this drugs exacerbated seizures. This adverse event is relatively uncommon at therapeutic dosages, and its incidence with some of most frequently used antidepressant drugs is close to that of spontaneous seizures calculated for the general population, but the incidence may rise up to 30-40% after overdosage. On the basis of the data reported in literature, it appears fair to say that maprotiline and amoxapine show the greatest seizure risk, whereas trazodone, fluoxetine and fluvoxamine show the least. The data also showed that antidepressant drugs may display both convulsant and anticonvulsant effect and it is likely that the most important factor to assess the effect of a given antidepressant drug in terms of inhibition-excitation is drug dosage. Nevertheless, further studies are needed in this field, both to clarify the complex modulating effects of antidepressants on seizure threshold and to identify clearer and safer guidelines to manage the treatment of patients with epilepsy and concomitant depression.
据报道，30%的癫痫患者会出现抑郁或抑郁症状。抑郁在发作期间和发作间期均有报道。对于发作频繁的患者，进行区分可能会很困难。然而，复杂部分性发作，尤其是位于颞叶的发作，似乎是病因，特别是在左侧癫痫病灶的男性患者中。接受联合治疗的患者，尤其是使用苯巴比妥和氨己烯酸治疗的患者，抑郁也更为常见。这种抑郁似乎是内源性的，在接受颞叶切除术的患者中也有描述。潜在的风险因素（遗传、代谢等）以及一些社会心理状况也起到一定作用，可能解释了癫痫患者中抑郁发生率增加的原因。治疗方法包括心理治疗、调整抗癫痫药物治疗方案以及抗抑郁治疗。在这些患者中使用抗抑郁治疗仍然存在不确定性，因为普遍认为这类药物会加重癫痫发作。这种不良事件在治疗剂量下相对不常见，某些最常用抗抑郁药物的发生率与一般人群中计算出的自发性癫痫发作发生率相近，但过量用药后发生率可能会升至30% - 40%。根据文献报道的数据，可以说马普替林和阿莫沙平显示出最大的癫痫发作风险，而曲唑酮、氟西汀和氟伏沙明显示出的风险最小。数据还表明，抗抑郁药物可能同时具有惊厥和抗惊厥作用，就抑制 - 兴奋作用而言，评估某种抗抑郁药物效果的最重要因素可能是药物剂量。然而，该领域仍需要进一步研究，以阐明抗抑郁药物对癫痫发作阈值的复杂调节作用，并确定更清晰、更安全的指南来管理癫痫合并抑郁患者的治疗。
