Kanner Andres M
Epilepsy Division and Department of Neurology, University of Miami, Miller School of Medicine, 1120 NW, 14th Street, Room 1324, Miami, FL 33136, USA.
Epilepsy Behav Rep. 2025 Feb 27;30:100758. doi: 10.1016/j.ebr.2025.100758. eCollection 2025 Jun.
Four to five patients with epilepsy (PWE) can suffer from Major Depressive episodes (MDE). Comorbid anxiety disorders (AD) frequently occur together with MDE. Failure to treat MDE can negatively affect several aspects of their life as well as the management of the epilepsy. Often, suicidal ideation is among its symptoms, which need to be addressed without delay to prevent suicidal attempts or a completed suicide. Unfortunately, access to health care professionals is very limited and, in many communities, non-existent. Accordingly, it falls upon the treating neurologist to begin a pharmacologic trial with psychotropic drugs. The purpose of this manuscript is to provide neurologists with very useful strategies on how to screen and identify MDEs with and without AD in the outpatient clinic and how to select the appropiate psychotropic drugs. Using an illustrative case, we discuss its differential diagnosis, particularly the recognition of iatrogenic episodes, and demonstrate the selection and mode of use of commonly used antidepressant in PWE. Finally, we provide a guide on how the neurologist can assess the suicidal risk of a patient that endorses suicidal ideation and the steps that need to be taken to minimize the risk of suicidal behavior.
四到五名癫痫患者（PWE）可能会出现重度抑郁发作（MDE）。共病焦虑症（AD）常与MDE同时出现。未能治疗MDE会对他们生活的多个方面以及癫痫的管理产生负面影响。通常，自杀观念是其症状之一，需要立即加以处理以防止自杀未遂或自杀成功。不幸的是，获得医疗保健专业人员的机会非常有限，而且在许多社区根本不存在。因此，应由主治神经科医生开始使用精神药物进行药物试验。本手稿的目的是为神经科医生提供非常有用的策略，说明如何在门诊筛查和识别伴有或不伴有AD的MDE，以及如何选择合适的精神药物。通过一个示例病例，我们讨论其鉴别诊断，特别是医源性发作的识别，并展示PWE中常用抗抑郁药的选择和使用方式。最后，我们提供一份指南，说明神经科医生如何评估有自杀观念患者的自杀风险以及为将自杀行为风险降至最低需要采取的步骤。
