Department of Neurology, Mayo Clinic in Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA,
Curr Treat Options Neurol. 2011 Aug;13(4):371-9. doi: 10.1007/s11940-011-0127-8.
In this article, we review the current best evidence for the treatment of depression in patients with epilepsy. Depression is a common epilepsy comorbidity, but it is often unrecognized. The most important step in appropriately managing mood disorders in this population is making the diagnosis. Clinical vigilance and routine use of a validated screening tool can improve detection and quality of care. As is increasingly the case for the general population, persons with epilepsy are often interested in exploring alternative therapies for chronic conditions, including depression. Unfortunately, the benefit of complementary and alternative therapies for depression currently is largely unproven for persons with a seizure history, although an early study of exercise for mild depression has shown some benefit. Concerns about drug interactions, side effects, and expense may be barriers to the prescription of antidepressant medications for people requiring chronic antiepileptic drug (AED) therapy. For this reason, use of an AED with mood-stabilizing properties has appeal and may be appropriate for selected individuals with mild depressive symptoms. Undue fear of lowering seizure threshold should not preclude the prescription of an antidepressant medication, as the perceived risks are often overestimated and rarely outweigh the risk of leaving depression untreated. At present, the best evidence for efficacy and safety support the use of citalopram, sertraline, or mirtazapine as initial pharmacotherapy, whereas bupropion should be avoided. Start low, go slow, and use the lowest effective dose. Cognitive behavioral therapy is a valuable adjunct to antidepressant therapy in this population. For people with refractory partial epilepsy and refractory depression, vagus nerve stimulation has some appeal, in that it may be beneficial for both conditions, but the efficacy of vagus nerve stimulation in improving mood in patients with epilepsy remains unclear.
在本文中，我们回顾了目前针对癫痫患者抑郁症治疗的最佳证据。抑郁症是一种常见的癫痫共病，但常常未被识别。在该人群中恰当地管理情绪障碍最重要的步骤是做出诊断。临床警觉和常规使用经过验证的筛查工具可以提高检测率并改善护理质量。与一般人群一样，癫痫患者经常对探索慢性疾病的替代疗法（包括抑郁症）感兴趣。不幸的是，对于有癫痫病史的患者，补充和替代疗法治疗抑郁症的益处目前在很大程度上尚未得到证实，尽管一项针对轻度抑郁症的运动早期研究显示出了一些益处。对药物相互作用、副作用和费用的担忧可能会成为需要长期抗癫痫药物（AED）治疗的人开抗抑郁药的障碍。出于这个原因，具有稳定情绪作用的 AED 的使用具有吸引力，并且可能适合某些轻度抑郁症状的个体。不应仅仅因为担心降低癫痫发作阈值而排除抗抑郁药的处方，因为人们对风险的认识往往被高估，而且很少超过不治疗抑郁症的风险。目前，疗效和安全性的最佳证据支持使用西酞普兰、舍曲林或米氮平作为初始药物治疗，而应避免使用安非他酮。起始剂量低，缓慢增加剂量，并使用最低有效剂量。认知行为疗法是该人群中抗抑郁治疗的一种有价值的辅助疗法。对于有难治性部分性癫痫和难治性抑郁症的患者，迷走神经刺激有一定吸引力，因为它可能对两种疾病都有益，但迷走神经刺激改善癫痫患者情绪的疗效仍不清楚。
