Mula Marco, Brodie Martin J, de Toffol Bertrand, Guekht Alla, Hecimovic Hrvoje, Kanemoto Kousuke, Kanner Andres M, Teixeira Antonio L, Wilson Sarah J
Institute of Medical and Biomedical Education, St George's University of London and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospital NHS Foundation Trust, London, UK.
Epilepsy Unit, University of Glasgow, Glasgow, UK.
Epilepsia. 2022 Feb;63(2):316-334. doi: 10.1111/epi.17140. Epub 2021 Dec 5.
The aim of this document is to provide evidence-based recommendations for the medical treatment of depression in adults with epilepsy. The working group consisted of members of an ad hoc Task Force of the International League Against Epilepsy (ILAE) Commission on Psychiatry, ILAE Executive and the International Bureau for Epilepsy (IBE) representatives. The development of these recommendations is based on a systematic review of studies on the treatment of depression in adults with epilepsy, and a formal adaptation process of existing guidelines and recommendations of treatment of depression outside epilepsy using the ADAPTE process. The systematic review identified 11 studies on drug treatments (788 participants, class of evidence III and IV); 13 studies on psychological treatments (998 participants, class of evidence II, III and IV); and 2 studies comparing sertraline with cognitive behavioral therapy (CBT; 155 participants, class of evidence I and IV). The ADAPTE process identified the World Federation of Societies of Biological Psychiatry guidelines for the biological treatment of unipolar depression as the starting point for the adaptation process. This document focuses on first-line drug treatment, inadequate response to first-line antidepressant treatment, and duration of such treatment and augmentation strategies within the broader context of electroconvulsive therapy, psychological, and other treatments. For mild depressive episodes, psychological interventions are first-line treatments, and where medication is used, selective serotonin reuptake inhibitors (SSRIs) are first-choice medications (Level B). SSRIs remain the first-choice medications (Level B) for moderate to severe depressive episodes; however, in patients who are partially or non-responding to first-line treatment, switching to venlafaxine appears legitimate (Level C). Antidepressant treatment should be maintained for at least 6 months following remission from a first depressive episode but it should be prolonged to 9 months in patients with a history of previous episodes and should continue even longer in severe depression or in cases of residual symptomatology until such symptoms have subsided.
本文档旨在为癫痫成年患者的抑郁症药物治疗提供循证建议。工作组由国际抗癫痫联盟（ILAE）精神病学委员会特设特别工作组的成员、ILAE执行委员会成员以及国际癫痫局（IBE）代表组成。这些建议的制定基于对癫痫成年患者抑郁症治疗研究的系统评价，以及使用ADAPTE流程对癫痫以外抑郁症治疗的现有指南和建议进行的正式改编过程。系统评价确定了11项关于药物治疗的研究（788名参与者，证据等级为III级和IV级）；13项关于心理治疗的研究（998名参与者，证据等级为II级、III级和IV级）；以及2项比较舍曲林与认知行为疗法（CBT）的研究（155名参与者，证据等级为I级和IV级）。ADAPTE流程确定将世界生物精神病学协会联合会关于单相抑郁症生物治疗的指南作为改编过程的起点。本文档重点关注一线药物治疗、对一线抗抑郁药治疗反应不足、此类治疗的持续时间以及在电休克治疗、心理治疗和其他治疗的更广泛背景下的增效策略。对于轻度抑郁发作，心理干预是一线治疗方法，若使用药物治疗，选择性5-羟色胺再摄取抑制剂（SSRIs）是首选药物（B级）。SSRIs仍然是中度至重度抑郁发作的首选药物（B级）；然而，对于部分或对一线治疗无反应的患者，换用文拉法辛似乎是合理的（C级）。首次抑郁发作缓解后，抗抑郁治疗应至少维持6个月，但有既往发作史的患者应延长至9个月，在重度抑郁症或有残留症状的情况下应持续更长时间，直至症状消退。
