癫癎合并抑郁

Depression in Patients with Epilepsy

抑郁是癫癎患者合并的最常见的精神障碍,约1/3的癫癎患者曾出现抑郁症状。抑郁和癫癎存在相关联的病理和解剖机制,如神经递质异常和海马萎缩,使得癫癎和抑郁在临床上的关联性有了病理和解剖基础。中国没有癫癎患者合并抑郁的诊断标准,建议使用NDDI-E量表或其他抑郁症筛查量表进行筛查。对于抑郁症状明确,且持续时间>2周的患者予以转诊精神科。抑郁症治疗建议应用抗抑郁药物,而不是具有心境稳定作用的抗癫癎药物,一线治疗推荐5-羟色胺再摄取抑制剂、5-羟色胺去甲肾上腺素再摄取抑制剂和三环类抗抑郁药。非药物疗法如电休克治疗和认知治疗的疗效尚不肯定。

Depression is the most common psycrnamc comormalty m pauents wire ~pn^p~y, ,~u~,u~ 1/3 of epilepsy patients had symptoms of depression. Depression and epilepsy have associated pathological and anatomical mechanisms, such as neurotransmitter abnormalities and hippocampal atrophy, which is a base to explain the high relevance of epilepsy and depression. In China, we have no diagnostic criteria for depression in patients with epilepsy. It is recommended to use NDDI-Escale or other depression screening scale when screening depressive symptoms in patients with epilepsy. For patients who had clear depressive symptoms lasting longer than two weeks, a transfer to psychiatric clinic is recommended. In depression treatment, SSRI, SNRI and tricyclic antidepressants are recommended, rather than antiepileptic drugs which have mood-stabilizing effect. The efficiency of non-drug treatments are uncertain, such as electroconvulsive therapy and cognitive therapy in patients with epilepsy.