a Institute of Medical and Biomedical Education , St George's University of London and The Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust , London , UK.
Expert Rev Neurother. 2019 Mar;19(3):269-276. doi: 10.1080/14737175.2019.1585244. Epub 2019 Mar 1.
Depression is one of the most frequent comorbidities in epilepsy affecting between 17% and 22% of patients, but it is still underdiagnosed and undertreated. Areas covered: This paper discusses recent advances about screening, diagnosis, and treatment of depression in epilepsy taking into account the heterogeneity of clinical scenarios where depression can occur. Expert opinion: A number of screening instruments are now validated for adults with epilepsy, and their psychometric properties are discussed but the NDDI-E is the most practical and cost-effective. Challenges in diagnosing depression in epilepsy are discussed including reasons for the atypical features of mood disorders in epilepsy. Psychological treatments and/or SSRIs are indicated, but the level of evidence is still low. Even if there is no reason to hypothesise that internationally accepted guidelines of treatment of depression outside epilepsy may not be valid, rigorous studies are needed in order to have proper outcome measures. Epilepsy centers should have well-defined care pathways for depression in order to provide access to mental health support when needed.
抑郁症是癫痫最常见的共病之一，影响 17%至 22%的患者，但它仍然未被充分诊断和治疗。
本文讨论了最近在癫痫患者中筛查、诊断和治疗抑郁症方面的进展，同时考虑到抑郁症可能发生的临床情况的异质性。
现在已经有一些筛查工具针对成年癫痫患者进行了验证，讨论了它们的心理测量特性，但 NDDI-E 是最实用和具有成本效益的。讨论了在癫痫中诊断抑郁症的挑战，包括癫痫中情绪障碍的非典型特征的原因。心理治疗和/或 SSRI 是指征，但证据水平仍然较低。即使没有理由假设国际上公认的癫痫以外的抑郁症治疗指南可能无效，但仍需要进行严格的研究，以便有适当的结果衡量标准。癫痫中心应该为抑郁症制定明确的护理路径，以便在需要时获得心理健康支持。
