Department of Epileptology, University Hospital Bonn, Bonn, Germany.
Neurological Department, National Center for Epilepsy, Oslo University Hospital, Oslo, Norway.
Epilepsia. 2024 Oct;65(10):3076-3082. doi: 10.1111/epi.18089. Epub 2024 Aug 14.
Screening for depression in people with epilepsy (PWE) is highly recommended in order to avoid underdiagnosis, misdiagnosis, or delayed diagnosis of this highly impacting comorbidity. Here we evaluated the impact of reporting and suggesting depression via the Beck Depression Inventory (BDI) on medical decision-making, and thereby the value of a depression screening for good medical practice.
Of 445 BDI data sets, PWE with scores indicating moderate (BDI 19-29) to severe depressive disorder (BDI >29) were extracted and clinical reports were retrospectively reviewed regarding decisions on antidepressants, anti-seizure medications (ASMs), and non-pharmaceutical interventions.
Sixty-four PWE (14%; 56% female; mean age 39.7 years) showed elevated BDI scores, with 40 (63%) categorized as moderate depression and 24 (37%) as severe depression. Thirty-nine percent of PWE already had a pre-existing diagnosis of depression and 53% left the clinic with the diagnosis of depression, half of them with antidepressants. High depression scores were associated with any intervention in 53%, interventions with potentially mood affecting ASM in 19%, treatment with antidepressants in 11%, and non-pharmaceutical interventions in 41%. Non-pharmaceutical interventions were related to BDI scores. Changes of potentially mood-affecting ASMs were more frequent in PWE with moderate scores, and introduction of antidepressants appeared as a trend related to higher depression scores.
The finding of an only weak relation between high depression scores, diagnoses of depression, and treatment consequences questions the diagnosis and treatment pathway and the clinical value of the BDI screening in PWE. Prospective standard procedures need to be established for depression diagnosis and treatment including follow-up evaluations of the validity of the diagnosis and effectiveness of the decisions taken.
强烈建议对癫痫患者（PWE）进行抑郁筛查，以避免漏诊、误诊或延迟诊断这种高度影响的共病。在这里，我们评估了通过贝克抑郁量表（BDI）报告和建议抑郁对医疗决策的影响，从而评估了抑郁筛查对良好医疗实践的价值。
从 445 份 BDI 数据集中，提取出评分表明中重度抑郁障碍（BDI 19-29）至重度抑郁障碍（BDI>29）的 PWE 数据，并回顾性审查临床报告，以了解关于抗抑郁药、抗癫痫药（ASM）和非药物干预的决策。
64 名 PWE（14%；56%为女性；平均年龄 39.7 岁）表现出升高的 BDI 评分，其中 40 名（63%）被归类为中度抑郁，24 名（37%）为重度抑郁。39%的 PWE 已经有抑郁症的预先诊断，53%的人离开诊所时被诊断为抑郁症，其中一半人服用了抗抑郁药。高抑郁评分与任何干预相关的占 53%，与可能影响情绪的 ASM 干预相关的占 19%，与抗抑郁药治疗相关的占 11%，与非药物干预相关的占 41%。非药物干预与 BDI 评分有关。中度评分的 PWE 中更频繁地出现潜在影响情绪的 ASM 变化，而抗抑郁药的引入似乎与较高的抑郁评分有关。
高抑郁评分、抑郁症诊断和治疗结果之间的关系仅存在微弱关系，这对诊断和治疗途径以及 BDI 筛查在 PWE 中的临床价值提出了质疑。需要为抑郁症的诊断和治疗建立前瞻性标准程序，包括对诊断的有效性和所做决策的效果进行后续评估。
