THE SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRI) AS TREATMENT OF DEPRESSION IN PATIENTS WITH EPILEPSY

The current possibilities of treatment of depression in epilepsy were represented. Depression is one of the most frequent psychiatric comorbidities  in epilepsy. The prevalence of depression  ranges from 10 to 80%, and most  often found in patients with focal epilepsy resistant to antiepileptic therapy. Depression in patients with epilepsy are not often diagnosed and therefore not treated. A number of common epilepsy and depression  pathogenetic mechanisms, such as impaired metabolism  of certain neurotransmitters  in the central nervous system, especially serotonin was descripted. Based on this, the most  promising  drugs in the treatment  of depression  in epilepsy  are now the selective  serotonin  reuptake inhibitor (SSRI), such  as escitalopram.  Objective. The primary objectives  were to evaluate the efficacy and safety  of escitalopram in treating depressive symptoms. Materials and  methods. The study involved 68 patients aged 19-69 years with cryptogenic and focal epilepsy and different disease duration (from 5 to 21 years), different types of seizures and suffering depression  interictal (between  2 and 5.5 years). Depression Rating Scale of Montgomery-Asberg (MADRS) was used.  To assess the severity of the patient ’s condition at the time of the survey, a global assessment of disease severity (CGI-S) and the global assessment of the mental state (CGI-I) were used. While taking escitalopram (10-20 mg per day.), all patients received basic anticonvulsant therapy. Results.  During follow-up the patients with epilepsy who took  escitalopram,  proconvulsant  effect  were not  denoted.  In assessing depressive  symptoms improved  markedly. Against the background of escitalopram no deterioration was marked, no sedation, addiction to the drug was observed, minimum drug interactions with anticonvulsants was registered. Conclusion. The results described observation program suggests a safe and effective treatment of escitalopram epilepsy patients with depression,  it is well tolerated, low drugdrug interactions, as well as improve the quality of life of patients.

1. Avakyan G. N. Epilepsiya i paroksizmal’nye sostoyaniya / Epilepsy and paroxysmal conditions. 2014; 4: 46-49.

2. Blinov D. V. Epilepsiya i paroksizmal’nye sostoyaniya / Epilepsy and paroxysmal conditions. 2011; 2: 28-33.

3. Vorob’eva O. V. Lechenie zabolevanii nervnoi sistemy. 2014; 3 (15): 17-23.

4. Gusev E. I., Burd G. S., Nikiforov A. S. Neurological symptoms, syndromes, symptom and disease [Nevrologicheskie simptomy, sindromy, simptomokompleksy i bolezni (In Russian)]. Moscow. 1999; 691.

5. Kalinin V. V. Depression in epilepsy. Modern epileptology. Ed. EI Gusev, AB Hecht [Depressii pri epilepsii. Sovremennaya epileptologiya. Pod red. E. I. Guseva, A. B. Gekht (In Russian)]. Moscow. 2011; 299-311.

6. Karlov V. A. Epilepsiya i paroksizmal’nye sostoyaniya / Epilepsy and paroxysmal conditions. 2014; 2: 71-79.

7. Kotov A. S. Epilepsiya i paroksizmal’nye sostoyaniya / Epilepsy and paroxysmal conditions. 2014; 3: 58.

8. Lebedeva A. V., Melikyan E. G., Gekht A. B. Zhurn. Nevrologiya, neiropsikhiatriya, psikhosomatika. 2011; 2: 50-56.

9. Lipatova L. V. Epilepsiya i paroksizmal’nye sostoyaniya / Epilepsy and paroxysmal conditions. 2010; 3: 20-27.

10. Mikhailov V. A. Epilepsiya i paroksizmal’nye sostoyaniya / Epilepsy and paroxysmal conditions. 2010; 3: 39-44.

11. Mosolov S. N. Clinical application of modern antidepressants [Klinicheskoe primenenie sovremennykh antidepressantov (In Russian)]. SPb. 1995; 565.

12. Sovremennaya epileptologiya: problem i resheniya. Pod red. E. I. Guseva, A. B. Gekht. M. 2015; 520.

13. Blanchet P., Frommer G. P. Mood change preceding epileptic seizures. J Nerv Ment Dis. 1986; 174: 471-476.

14. Blumer D., Herzog A. G., Himmelhoch J. et al. To what extent do premenstrual and interictal dysphoric disorders overlap? Significance for therapy. J Affect Disorders. 1998; 48: 215-25.

15. Blumer D. Dysphoric disorders and paroxysmal affects: recognition and treatment of epilepsy – related psychiatric disorders. Harvard Rev Psychiatry. 2000; 8: 8-17.

16. Borges Gonçalves E., Cendes F. Depression in patients with refractory temporal lobe epilepsy. Arq Neuropsiquiatr. 2011; 69 (5): 775-777.

17. Buchanan G. F. et.al. Serotonin neurones have anti-convulsant effects and reduc seizure-induced mortality. J Physiol. 2014 Oct 1; 592 (19): 4395-410.

18. Eddy M., Hugh E. Rickards, Andrea E. The cognitive impact of antiepileptic drugs. Ther Adv Neurol Disord. 2011; 4 (6): 385-407.

19. Gilliam F. G., Santos J., Vahle V. et al. Depression in epilepsy: ignoring clinical expression of neuronal network dysfunction? Epilepsia. 2004; 46 (2): 28-33.

20. Jacoby A., Baker G. A., Steen N. et al. The clinical course of epilepsy and ets psychosocial correlates: findings from a U.K. community study. Epilepsy. 1996; 37: 148-61.

21. Harden C. The co-morbidity of depression and epilepsy: epidemiology, etiology, and treatment. Neurology. 2002; 59 (6 suppl 4): 48-55.

22. Kanner A. M. Depression and Epilepsy: A New Perspective on Two Closely Related Disorders. Epilepsy Currents. 2006; 6 (5): 141-146.

23. Kanner A. M. Recognition of the various expressions of anxiety, psychosis, and aggression in epilepsy. Epilepsia. 2004; 45 (2): 22-7.

24. Kanner A. Depression in epilepsy: prevalence, clinical semiology, pathogenic mechanisms, and treatment. Biol Psychiatry. 2003; 54: 388-398.

25. Kanner A. M., Balabanov A. Depression and epilepsy: how closely related are they? Neurology. 2002; 58 (8 suppl 5): 27-39.

26. Kanner A. M., Kozak A. M., Frey M. The use of sertralin in patients with epilepsy: is it safe Epilepsy Behav. 2000; 1 (2): 100-105.

27. Kanner A. M., Soto A. et al. Prevalence and clinical characteristic of postictal psychiatric symptoms in partial epilepsy. Neurology. 2004; 62: 708-713.

28. Kanner A. M., Wuu J. et al. A past psychiatric history may be a risk factor for topiramatrelated psychiatric and cognitive adverse events. Epilepsy Behav. 2003: 4: 548-552.

29. Maguire M. J. et.al. Antidepressants for people with epilepsy and depression. Cochrane Database Syst Rev. 2014 Dec 3; 12.

30. Mendez M. F., Cummings J., Benson D. et al. Depression in epilepsy. Significance and phenomenology. Arch Neurol. 1986; 43: 766-770.