Villanueva Vicente, Artal Jesús, Cabeza-Alvarez Clara-Isabel, Campos Dulce, Castillo Ascensión, Flórez Gerardo, Franco-Martin Manuel, García-Portilla María Paz, Giráldez Beatriz G, Gotor Francisco, Gutiérrez-Rojas Luis, Albanell Albert Molins, Paniagua Gonzalo, Pintor Luis, Poza Juan José, Rubio-Granero Teresa, Toledo Manuel, Tortosa-Conesa Diego, Rodríguez-Uranga Juan, Bobes Julio
Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
Psychiatry Department, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Spain.
Neurol Ther. 2023 Apr;12(2):479-503. doi: 10.1007/s40120-023-00437-0. Epub 2023 Jan 24.
Experts agree that there is a need for protocols to guide health professionals on how to best manage psychiatric comorbidities in patients with epilepsy (PWE). We aimed to develop practical recommendations for key issues in the management of depression in PWE.
This was a qualitative study conducted in four steps: (1) development of a questionnaire on the management of depression in PWE to be answered; (2) literature review and, if evidence from guidelines/consensus or systematic reviews was available, drafting initial recommendations; (3) a nominal group methodology for reviewing initial recommendations and formulating new recommendations on those issues without available evidence; and (4) drafting and approving the final recommendations. A scientific committee (one neurologist and one psychiatrist) was responsible for the development of the project and its scientific integrity. The scientific committee selected a panel of experts (nine neurologists and nine psychiatrists with experience in this field) to be involved in the nominal group meetings and to formulate final recommendations.
Fifteen recommendations were formulated. Four on the screening and diagnosis: screening and diagnosis of depression, evaluation of the risk of suicide, and diagnosis of depression secondary to epilepsy; nine on the management of depression: referral to a psychiatrist, selection of the antiseizure medication, change of antiseizure medication, antidepressant treatment initiation, selection of antidepressant, use of antidepressants during pregnancy, use of psychotherapy, antidepressant treatment duration, and discontinuation of antidepressant treatment; two on the follow-up: duration of the follow-up under usual conditions, and follow-up of patients at risk of suicide.
We provide recommendations based on expert opinion consensus to help healthcare professionals assess depression in PWE. The detection and treatment of major depressive disorders are key factors in improving epilepsy outcomes and avoiding suicide risk.
专家们一致认为，需要制定相关方案，以指导医疗专业人员如何最好地管理癫痫患者（PWE）的精神疾病合并症。我们旨在针对PWE抑郁症管理中的关键问题制定实用建议。
这是一项分四个步骤进行的定性研究：（1）编制一份关于PWE抑郁症管理的问卷以供回答；（2）进行文献综述，若有指南/共识或系统评价的证据，则起草初步建议；（3）采用名义小组法审查初步建议，并就无现有证据的问题制定新建议；（4）起草并批准最终建议。一个科学委员会（一名神经科医生和一名精神科医生）负责项目的开展及其科学完整性。科学委员会挑选了一组专家（九名有该领域经验的神经科医生和九名精神科医生）参与名义小组会议并制定最终建议。
制定了十五条建议。四条关于筛查和诊断：抑郁症的筛查和诊断、自杀风险评估以及癫痫继发抑郁症的诊断；九条关于抑郁症的管理：转诊至精神科医生、抗癫痫药物的选择、抗癫痫药物的更换、开始抗抑郁治疗、抗抑郁药的选择、孕期使用抗抑郁药、心理治疗的使用、抗抑郁治疗持续时间以及抗抑郁治疗的停药；两条关于随访：常规条件下的随访持续时间以及对有自杀风险患者的随访。
我们基于专家意见共识提供建议，以帮助医疗保健专业人员评估PWE的抑郁症。重度抑郁症的检测和治疗是改善癫痫预后和避免自杀风险的关键因素。
