People with epilepsy (PWE) frequently suffer from comorbid mood and anxiety disorders. Depression is one of the major psychiatric comorbidities having a negative impact on the quality of life in people with epilepsy. A review of the literature indicates that the majority of antidepressant-related seizures have been associated with either ultra-high doses or overdosing and, generally, the risk of antidepressant-associated seizures is low. Correspondingly, there is some evidence indicating that antidepressants of most widely used groups may additionally lower the risk of triggering seizures. Four antidepressants are not recommended for patients with epilepsy, i.e.: amoxapine, bupropion, clomipramine and maprotiline. Clinicians applying first line of depression treatment in patients with epilepsy should consider use of SSRIs or SNRIs, particularly sertraline, citalopram, mirtazapine, reboxetine, paroxetine, fluoxetine, escitalopram, fluvoxamine, venlafaxine, duloxetine. Implementation of anticonvulsive drugs in depressed patients should include valproate, carbamazepine, lamotrigine, gabapentin, pregabalin. The paper reviews the evidence for the clinical use of antidepressants in PWE.

Introduction

People with epilepsy (PWE) frequently suffer from comorbid mood disorders. Lifetime prevalence ranges between 11% and 62% [1]. One of the major psychiatric comorbidities having a negative impact on the quality of life in PWE is depression [2]. The relationship between depression and epilepsy may be bidirectional; having depression would increase the risk of epilepsy, and having epilepsy appears to increase the risk of depression [3]. Suicide attempts among depressed PWE are four- to fivefold more frequent than in the general population [4–۶]. Depression has also been associated with higher rates of drug resistance in PWE [7]. Considering these issues the successful and safe treatment of depression associated with epilepsy is of utmost clinical importance. Also psychotherapy must be mentioned as effective and safe therapeutic intervention in PWE suffering from depression [8]. Guidelines indicating the choice of psychotropic drugs in PWE are mainly based on studies in patients without epilepsy, as well as risk evaluation of seizures [9,10]. Antidepressants may impact the incidence of seizures in a dose-related manner in line with the animal model of epilepsy [11]. The anticonvulsive effect is noticed at low doses and with the increase of the dose the effect is being reversed [12]. A review of the literature indicates that most antidepressant-related seizures have been associated with either ultrahigh doses or particularly in overdosing [13]. The paper reviews best practice indications for antidepressant treatment in patients with epilepsy.

چکیده

بیماران مبتلا به صرع (به اصطلاح: PWE) غالباً از اختلالات رفتاری و اضطراب به طور همزمان رنج می‌برند. افسردگی یکی از مهم ترین اختلالات روانپزشکی است که به طور مستقیم بر روی کیفیت زندگی بیماران مبتلا به صرع تاثیر منفی می‌گذارد. بررسی‌ها نشانگر آن است که اکثر تشنج‌های ناشی از داروهای ضدافسردگی به دلیل دوزهای بسیار بالا صورت می‌گیرد و بدین ترتیب، خطر تشنج ناشی از مصرف داروهای ضدافسردگی کم می‌باشد.این در حالی است که شواهد نشان می‌دهد داروهای ضدافسردگی مورداستفاده ریسک ابتلا به تشنج را نیز کاهش می‌دهند. چهار داروی ضدافسردگی برای بیماران مبتلا به صرع توصیه نمی‌گردد که از آنها می‌توان به آموکساپین، بوپروپیون، کلومیپرامین و ماپروتیلین اشاره نمود. متخصصان بالینی در وهلۀ نخست باید در خصوص بیماران مبتلا به صرع اس‌اس‌آرآی‌ها و اس‌ان‌آرآی‌ها به ویژه سرتالین، سیتالوپرام، میرتازاپین، ربوکستین، پاروکستین، فلوکستین، اسیتالوپرام، فلووکسامین، ونلافاکسین و دولوکستین را تجویز نمایند.