Błaszczyk Barbara, Czuczwar Stanisław J
Faculty of Health Sciences, High School of Economics, Law and Medical Sciences, Kielce, Poland; Private Neurological Practice, Kielce, Poland.
Department of Pathophysiology, Medical University of Lublin, Lublin, Poland; Department of Physiopathology, Institute of Rural Health, Lublin, Poland.
Pharmacol Rep. 2016 Oct;68(5):1084-92. doi: 10.1016/j.pharep.2016.06.011.
Depression episodes in epilepsy is the most common commorbidity, affecting between 11% and 62% of patients with epilepsy. Although researchers have documented a strong association between epilepsy and psychiatric comorbidities, the nature of this relationship is poorly understood. The manifestation of depression in epilepsy is a complex issue having many interacting neurobiological and psychosocial determinants, including clinical features of epilepsy (seizure frequency, type, foci, or lateralization of foci) and neurochemical or iatrogenic mechanisms. Other risk factors are a family history of psychiatric illness, particularly depression, a lack of control over the seizures and iatrogenic causes (pharmacologic and surgical). In addition, treatment with antiepileptic drugs (AEDs) as well as social coping and adaptation skills have also been recognised as risk factors of depression associated with epilepsy. Epilepsy may foster the development of depression through being exposed to chronic stress. The uncertainty and unpredictability of seizures may instigate sadness, loneliness, despair, low self-esteem, and self-reproach in patients with epilepsy and lead to social isolation, stigmatization, or disability. Often, depression is viewed as a reaction to epilepsy's stigma and the associated poor quality of life. Moreover, patients with epilepsy display a 4-5 higher rate of depression and suicide compared with healthy population.
癫痫伴发的抑郁发作是最常见的共病情况，影响着11%至62%的癫痫患者。尽管研究人员已记录到癫痫与精神共病之间存在紧密关联，但这种关系的本质却鲜为人知。癫痫中抑郁的表现是一个复杂的问题，有许多相互作用的神经生物学和社会心理决定因素，包括癫痫的临床特征（发作频率、类型、病灶或病灶的定位）以及神经化学或医源性机制。其他风险因素包括精神疾病家族史，尤其是抑郁症家族史、癫痫发作控制不佳以及医源性原因（药物和手术）。此外，抗癫痫药物（AEDs）治疗以及社会应对和适应技能也被认为是与癫痫相关的抑郁的风险因素。癫痫可能通过长期暴露于慢性应激而促进抑郁的发展。癫痫发作的不确定性和不可预测性可能会引发癫痫患者的悲伤、孤独、绝望、自卑和自责，并导致社会隔离、污名化或残疾。通常，抑郁被视为对癫痫污名及其相关低生活质量的一种反应。此外，与健康人群相比，癫痫患者的抑郁和自杀发生率高出4至5倍。
