Siwek Marcin, Gorostowicz Aleksandra, Bosak Magdalena, Dudek Dominika
Department of Affective Disorders, Jagiellonian University Medical College, Kraków, Poland.
Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland.
Front Pharmacol. 2022 Mar 31;13:852042. doi: 10.3389/fphar.2022.852042. eCollection 2022.
Epilepsy and depression are both serious and potentially disabling conditions which often coexist-bidirectional relationship between the two disorders has been observed. Comorbidity between depression and epilepsy can be attributed to: underlying common pathophysiological mechanisms, psychiatric side effect of antiepileptic medications and psychological response to stress in people with chronic, neurological condition. Despite high prevalence of depressive symptoms in patients with epilepsy, current evidence of the effectiveness of antidepressant therapy in this group of patients is very limited. Vortioxetine is an antidepressant with multimodal activity, very good treatment tolerability, low risk of inducing pharmacokinetic interactions, relative safety of treatment in patients with somatic comorbidities, low risk of causing: sedation, sexual dysfunctions and metabolic side effects. Vortioxetine seems to be a promising treatment option for depressed patients with cognitive dysfunctions, anhedonia and anxiety. In this case series, we report nine cases of patients with epilepsy and depressive symptoms treated with vortioxetine. Seven cases are patients with secondary focal and generalized epilepsy and two with unclassified epilepsy. Three patients presented with depressive episode in the course of bipolar disorder and six patients had depressive symptoms due to organic mood disorder. The dose range of vortioxetine was between 10 and 20 mg. In all of the presented cases effectiveness and tolerability of treatment were very good. Remission of depressive symptoms was achieved in all patients. No epilepsy seizures after switch to vortioxetine were observed in seven cases. In two patients seizures occurred during the first months of vortioxetine treatment but this most probably was due to suboptimal antiepileptic treatment-satisfactory seizure control was achieved after optimization of antiepileptic pharmacotherapy. Vortioxetine was discontinued in two of the presented cases due to pregnancy planning. The duration of observation period during vortioxetine therapy ranged from 2 to 48 months. In conclusion, vortioxetine can be a promising treatment option in patients with epilepsy and comorbid depressive symptoms.
癫痫和抑郁症都是严重且可能导致残疾的疾病，它们常常并存，并且已观察到这两种疾病之间存在双向关系。抑郁症与癫痫的共病可归因于：潜在的共同病理生理机制、抗癫痫药物的精神副作用以及慢性神经疾病患者对压力的心理反应。尽管癫痫患者中抑郁症状的患病率很高，但目前关于抗抑郁治疗在这组患者中有效性的证据非常有限。伏硫西汀是一种具有多模式活性的抗抑郁药，治疗耐受性非常好，诱导药代动力学相互作用的风险低，对伴有躯体共病的患者治疗相对安全，引起镇静、性功能障碍和代谢副作用的风险低。伏硫西汀似乎是治疗伴有认知功能障碍、快感缺失和焦虑的抑郁症患者的一种有前景的治疗选择。在本病例系列中，我们报告了9例使用伏硫西汀治疗的癫痫伴抑郁症状患者。7例为继发性局灶性和全身性癫痫患者，2例为未分类癫痫患者。3例患者在双相情感障碍病程中出现抑郁发作，6例患者因器质性心境障碍出现抑郁症状。伏硫西汀的剂量范围为10至20毫克。在所有呈现的病例中，治疗的有效性和耐受性都非常好。所有患者的抑郁症状均得到缓解。7例患者在换用伏硫西汀后未观察到癫痫发作。2例患者在伏硫西汀治疗的最初几个月出现癫痫发作，但这很可能是由于抗癫痫治疗不理想，在优化抗癫痫药物治疗后实现了满意的癫痫控制。在其中2例呈现的病例中，由于计划生育停用了伏硫西汀。伏硫西汀治疗期间的观察期为2至48个月。总之，伏硫西汀可能是癫痫伴共病抑郁症状患者的一种有前景的治疗选择。
