Department of Neurological Sciences, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
Epilepsy Behav. 2012 Jun;24(2):169-81. doi: 10.1016/j.yebeh.2012.01.008.
The clinical manifestations of depression in people with epilepsy (PWE) are pleomorphic, often associated with anxiety symptoms and anxiety disorders. The ongoing debate of whether the clinical presentation of depression in PWE is unique to this neurologic disorder is reviewed. Comorbid depression can impact the recruitment of PWE for pharmacologic trials with antiepileptic drugs (AEDs). Yet, the impact of depression on the response of the seizure disorder to pharmacotherapy with AEDs and its impact on worse adverse events may bias the interpretation of the trial findings, particularly when depressed patients are included in the AED trials. PWE have a greater suicidal risk than the general population. This risk is mediated by multiple factors, and recent data from the FDA have imputed a potential pathogenic role to all AEDs. The recognition of patients at risk is reviewed. Yet, the validity of the FDA data has been questioned, and the status of this controversial question is analyzed. As in the case of epilepsy, depression and pain syndromes have a relatively high comorbidity. The negative impact of depression on pain is reminiscent of that of depression in PWE; furthermore, the high comorbidity may be also associated with the existence of common pathogenic mechanisms. Neurologists and in particular, epileptologists establish the diagnosis of psychogenic non-epileptic seizures (PNES) in whom a comorbid depressive disorder is very often identified. The role of depression in the course of PNES and its treatment are discussed. Scarce data are available on the treatment of depression in PWE. Thus, clinicians have had to adopt data from patients with primary depressive disorders. We outline a consensus strategy on the identification and treatment of depressive disorders in adult and pediatric patients with epilepsy.
癫痫患者（PWE）的抑郁临床表现多种多样，常伴有焦虑症状和焦虑障碍。目前仍在争论 PWE 中抑郁的临床表现是否与这种神经障碍有关。共病抑郁会影响抗癫痫药物（AED）药物治疗的 PWE 招募。然而，抑郁对 AED 药物治疗癫痫发作障碍的反应以及对更严重不良事件的影响可能会影响对试验结果的解释，尤其是当抑郁患者被纳入 AED 试验时。PWE 的自杀风险高于一般人群。这种风险受多种因素影响，最近来自 FDA 的数据提示所有 AED 都可能具有潜在的致病作用。本文回顾了风险患者的识别。然而，FDA 数据的有效性受到了质疑，并且对这个有争议的问题的现状进行了分析。与癫痫一样，抑郁和疼痛综合征的共病率相对较高。抑郁对疼痛的负面影响与 PWE 中的抑郁相似；此外，高共病率也可能与共同的发病机制有关。神经科医生，特别是癫痫学家，诊断为心因性非癫痫性发作（PNES），其中经常发现共病抑郁障碍。本文讨论了抑郁在 PNES 病程及其治疗中的作用。关于 PWE 中抑郁的治疗，数据有限。因此，临床医生不得不采用原发性抑郁障碍患者的数据。我们概述了针对癫痫成年和儿科患者识别和治疗抑郁障碍的共识策略。
