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癫痫共病抑郁研究进展
作者:李海滨1  黄啸2 
单位:1. 复旦大学附属中山医院 心理医学科, 上海 200032;
2. 复旦中山厦门医院 心理医学科, 福建 厦门 361015
关键词:癫痫 抑郁 机制 治疗 药物 综述 
分类号:R749.17;R749.4;R749.05
出版年·卷·期(页码):2020·39·第五期(682-688)
摘要:

癫痫是一类相对高发的神经系统疾病,很多患者同时伴有抑郁症状,显著影响患者生存质量,增加自杀风险。越来越多研究表明癫痫与抑郁可能存在共同发病机制。影像学研究提示,海马萎缩可能是癫痫共病抑郁的一个重要因素。下丘脑-垂体-肾上腺轴(HPA)功能失调和炎症反应参与其中,双加氧酶激活后色氨酸代谢通路中有毒代谢产物增加,氧化/硝化应激通路激活后氧自由基和氮自由基增加,导致HPA轴功能失调从而影响患者情绪。脑源性神经营养因子(BDNF)、5-羟色胺(5-HT)、谷氨酸、星形胶质细胞等参与神经细胞生长、死亡等调控,影响癫痫及抑郁。癫痫共病抑郁症状往往不典型,诊断上存在一定难度,可以采取多种量表综合评估。癫痫共病抑郁患者治疗可以采取认知行为治疗、物理治疗以及药物治疗,药物治疗首选抗癫痫药物,多项研究显示5-HT再摄取抑制剂、5-HT 和去甲肾上腺素再摄取抑制剂也是安全的选择。目前对癫痫共病抑郁的了解还远远不够,需要进一步对其发病机制、诊疗进行探索。

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