Hesdorffer Dale C, Lee Philip
Gertrude H. Sergievsky Center and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
Epilepsy Behav. 2009 Jun;15 Suppl 1:S36-40. doi: 10.1016/j.yebeh.2009.03.006. Epub 2009 Apr 5.
Depression is the most common psychological morbidity in epilepsy, yet this comorbidity is not well understood. Possible explanations for this comorbidity include recurrence of premorbid depression, increased risk for severe epilepsy due to a history of depression, shared risk factors for depression and epilepsy, AED-induced depression in vulnerable individuals, and coping styles in the face of stressors linked to epilepsy. Preexisting vulnerability to depression may contribute to each of these explanations. Vulnerability may arise from the influence of common risk factors, family history of depression, a history of depression before initiation of relevant AEDs, or coping styles and may reflect allostatic load. These exposures may precede the occurrence of epilepsy or follow the onset of epilepsy, in both cases increasing the risk for depression in prevalent epilepsy. Their careful evaluation is vital to identifying people at greatest risk for depression in epilepsy and for informing interventions to prevent the occurrence of this disabling epilepsy comorbidity.
抑郁症是癫痫中最常见的心理疾病，但这种共病情况尚未得到充分理解。这种共病的可能解释包括病前抑郁症的复发、因抑郁症病史导致严重癫痫的风险增加、抑郁症和癫痫的共同风险因素、易患个体中抗癫痫药物（AED）诱发的抑郁症以及面对与癫痫相关的应激源时的应对方式。先前存在的抑郁症易感性可能与这些解释中的每一个都有关。易感性可能源于常见风险因素的影响、抑郁症家族史、在开始使用相关抗癫痫药物之前的抑郁症病史或应对方式，并且可能反映了应激负荷。这些暴露可能发生在癫痫发作之前或癫痫发作之后，在这两种情况下都会增加现患癫痫患者患抑郁症的风险。对它们进行仔细评估对于识别癫痫患者中患抑郁症风险最高的人群以及为预防这种致残性癫痫共病的发生提供干预措施至关重要。
