Zimbrean Paula C, Jakab Simona S
Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.
Department of Medicine (Digestive Disease), Yale School of Medicine, New Haven, Connecticut, USA.
Hepatol Commun. 2024 Dec 11;9(1). doi: 10.1097/HC9.0000000000000600. eCollection 2025 Jan 1.
Depressive and anxiety symptoms are more prevalent in patients with cirrhosis compared to the general population. Between 2009 and 2019, the prevalence of depression in cirrhosis increased by 80%, while the prevalence of generalized anxiety disorder increased by over 400%. When present, anxiety and depression are linked to lower health-related quality of life, more severe symptoms (eg, fatigue), and poorer response to medical treatment. Screening instruments for depression and anxiety have shown acceptable validity in patients with cirrhosis. However, the diagnosis of depression and anxiety disorder remains challenging in this population and should follow the established criteria for general populations. Treatment interventions are numerous and include patient education and support around liver disease, pharmacological agents, and psychotherapy. Antidepressants are the treatment of choice for patients with depressive or anxiety disorder and cirrhosis. However, consideration must be given to dose adjustment and choice of agent due to changes in their metabolism in patients with liver disease. Psychotherapy may be used as a stand-alone therapy or concomitantly with pharmacotherapy. The high prevalence and complexity of depressive and anxiety symptoms in patients with cirrhosis support the integrated care approach in which patients are cared for by multidisciplinary teams.
与普通人群相比，肝硬化患者中抑郁和焦虑症状更为普遍。在2009年至2019年期间，肝硬化患者中抑郁症的患病率增加了80%，而广泛性焦虑症的患病率增加了400%以上。焦虑和抑郁症状一旦出现，就会与较低的健康相关生活质量、更严重的症状（如疲劳）以及对医疗治疗的较差反应相关联。用于筛查抑郁和焦虑的工具在肝硬化患者中已显示出可接受的有效性。然而，在这一人群中，抑郁和焦虑症的诊断仍然具有挑战性，应遵循针对普通人群的既定标准。治疗干预措施多种多样，包括围绕肝病的患者教育和支持、药物治疗以及心理治疗。抗抑郁药是患有抑郁或焦虑症及肝硬化患者的首选治疗药物。然而，由于肝病患者药物代谢的变化，必须考虑剂量调整和药物选择。心理治疗可以作为独立治疗方法使用，也可以与药物治疗同时进行。肝硬化患者中抑郁和焦虑症状的高患病率和复杂性支持采用多学科团队对患者进行护理的综合护理方法。
