老年癫痫患者的抑郁症：病理生理学及管理考量
Depression in older adults with epilepsy: Pathophysiology and management considerations.
作者信息
Sadek Michael, Chemali Zeina, Sarkis Rani A
机构信息
Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, United States.
Department of Neurology, Massachusetts General Hospital, Boston, United States; Division of Neuropsychiatry, Massachusetts General Hospital, Boston, United States.
出版信息
Epilepsy Behav. 2025 Sep 1;172:110692. doi: 10.1016/j.yebeh.2025.110692.
Older adults with epilepsy are at an increased risk for comorbid depression, which worsens their quality of life. This review aims to outline the pathophysiological mechanisms thought to underly the comorbidity of depression in older adults with epilepsy and propose clinical and pharmacological considerations for the holistic management of depression in this population. Indeed, there is a wide range of reported prevalence of depression in older adults with epilepsy, yet these are likely underestimates since depression is underdiagnosed in this population. Age-related drivers of depression include biological and social risk factors such as neurodegenerative changes, inflammation, cerebrovascular dysfunction, social isolation, stigma, and poor health status. Additional contributors related to epilepsy include the impact of seizures, the effects of anti-seizure medications, and the role of sleep-disordered breathing. Therefore, the management of depression in older adults with epilepsy is centered on screening for depression and obstructive sleep apnea, careful choice of anti-seizure medications and anti-depressants, and the provision of social and psychological support.
患有癫痫的老年人患合并抑郁症的风险增加，这会降低他们的生活质量。本综述旨在概述被认为是老年癫痫患者抑郁症合并症基础的病理生理机制，并提出针对该人群抑郁症整体管理的临床和药理学考虑。事实上，有大量关于老年癫痫患者抑郁症患病率的报道，但这些可能被低估了，因为该人群中抑郁症的诊断不足。与年龄相关的抑郁症驱动因素包括生物和社会风险因素，如神经退行性变化、炎症、脑血管功能障碍、社会隔离、耻辱感和健康状况不佳。与癫痫相关的其他因素包括癫痫发作的影响、抗癫痫药物的作用以及睡眠呼吸障碍的作用。因此，老年癫痫患者抑郁症的管理集中在筛查抑郁症和阻塞性睡眠呼吸暂停、谨慎选择抗癫痫药物和抗抑郁药，以及提供社会和心理支持。
Zotero 插件