Diagnosing and treating depression in epilepsy

被引:58
作者
Elger, Christian E. [1 ]
Johnston, Samantha A. [2 ]
Hoppe, Christian [1 ]
机构
[1] Univ Bonn, Med Ctr, Dept Epileptol, Sigmund Freud Str 25, Bonn, Germany
[2] Univ Sheffield, Royal Hallamshire Hosp, Acad Neurol Unit, Glossop Rd, Sheffield S10 2JF, S Yorkshire, England
来源
SEIZURE-EUROPEAN JOURNAL OF EPILEPSY | 2017年 / 44卷
关键词
Depression comorbidity in epilepsy; Burden of epilepsy; Diagnosting depressive disorders; Psychotherapy; Antidepressive drugs; Endogenous depression; TEMPORAL-LOBE EPILEPSY; COGNITIVE-BEHAVIOR THERAPY; NEW-ONSET EPILEPSY; QUALITY-OF-LIFE; INTERICTAL DYSPHORIC DISORDER; DRUG-REFRACTORY EPILEPSY; MAJOR DEPRESSION; ANTIDEPRESSANT DRUGS; LIMBIC ENCEPHALITIS; COMMITMENT THERAPY;
D O I
10.1016/j.seizure.2016.10.018
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
At least one third of patients with active epilepsy suffer from significant impairment of their emotional well-being. A targeted examination for possible depression (irrespective of any social, financial or personal burdens) can identify patients who may benefit from medical attention and therapeutic support. Reliable screening instruments such as the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) are suitable for the timely identification of patients needing help. Neurologists should be capable of managing mild to moderate comorbid depression but referral to mental health specialists is mandatory in severe and difficult-to-treat depression, or if the patient is acutely suicidal. In terms of the therapeutic approach, it is essential first to optimize seizure control and minimize unwanted antiepileptic drug-related side effects. Psychotherapy for depression in epilepsy (including online self-treatment programs) is underutilized although it has proven effective in ten well-controlled trials. In contrast, the effectiveness of antidepressant drugs for depression in epilepsy is unknown. However, if modern antidepressants are used (e.g. SSRI, SNRI, NaSSA), concerns about an aggravation of seizures and or problematic interactions with antiepileptic drugs seem unwarranted. Epilepsy-related stress ("burden of epilepsy") explains depression in many patients but acute and temporary seizure-related states of depression or suicidality have also been reported. Limbic encephalitits may cause isolated mood alteration without any recognizable psychoetiological background indicating a possible role of neuroinflammation. This review will argue that, overall, a bio-psycho-social model best captures the currently available evidence relating to the etiology and treatment of depression as a comorbidity of epilepsy. (C) 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:184 / 193
页数:10
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