Epilepsy and Mood Disorders

Yıl 2012, Cilt: 4 Sayı: 1, 51 - 68, 01.03.2012

Sermin Kesebir Sertaç Güven İsmail Koç

https://doi.org/10.5455/cap.20120404

Öz

Mood disorders are the most common psychiatric comorbid disorder that affects quality of life and prognosis in epilepsy. The relation between depression and epilepsy is bidirectional. Not only the risk of having a depression among epilepsy cases is more than the healthy control cases, but also the risk of having epilepsy among depressive cases is more than the healthy control cases. People diagnosed with epilepsy are five times more likely than their peers to commit suicide. Moreover it seems that some epilepsy types like temporal lobe epilepsy have a much higher risk (25 times) for suicide. Risk of suicide in epilepsy, which is independent from depression, increases more with the presence of depression. The common pathway between epilepsy, depression and suicide is hypofrontality and irregularity of serotonin metabolism. Contrary to depression, data on relationship between bipolar disorder and epilepsy is limited. However, mood disorder, mixed episodes with irritable character and mania are more frequent than assumed. As a matter of fact, both disorders share some common features. Both are episodic and can become chronic. Kindling phenomenon, irregularities in neurotransmitters, irregularities in voltage gate ion channels and irregularities in secondary messenger systems are variables that are presented in the etiologies of both disorders. Anticonvulsant drugs with mood regulatory effects are the common points of treatment. Understanding their mechanisms of action will clarify the pathophysiological processes. In this article, the relationhip between epilepsy and mood disorders, comorbidity, secondary states and treatment options in both cases have been discussed.

Anahtar Kelimeler

Epilepsy, depression, bipolar disorder

Epilepsi ve Duygudurum Bozuklukları

Öz

Duygudurum bozuklukları epilepside yaşam kalitesini ve prognozu etkileyen önemli bir psikiyatrik eştanıdır. Depresyon ile epilepsi arasındaki ilişki çift yönlüdür. Epileptik olgular arasındaki depresyon geliştirme riski sağlıklı kont-rollerden yüksek olduğu kadar, depresif olgular arasında da epilepsi geliştirme riski sağlıklı kontrollerden yüksektir. Özkıyım epilepside beş kat, temporal lob epilepsisinde 25 kat artar. Epilepside depresyondan bağımsız var olan özkıyım riski, depresyonun varlığında daha da artar. Epilepsi, depresyon ve özkıyım arasındaki ortak yol hipofrontalite ve serotonin metabolizmasındaki düzensizliktir. Dizin daha çok depresyonla ilgili bilgi sağlarken bipolar bozuklukla ilgili veriler daha sınırlıdır. Oysa duygudurum düzensizliği, irritabilite ile karakterli karma dönemler ve mani sanıldığından daha sıktır. Her iki bozukluk da döngüsel olup süregenleşebilir. Ateşleme fenomeni, nörotransmiter, voltaj kapılı iyon kanallarında ve ikincil mesajcı sistemlerdeki düzensizlikler her iki bozukluğun etiyolojisinde öne sürülen değişikliklerdir. Duygudurum düzenleyici etkileri olan antikonvülzan ilaçlar ortak tedavi noktasını oluşturmaktadır. Bu ilaçların etki mekanizmalarının anlaşılması patofizyolojik süreçlere ışık tutacaktır. Bu yazıda epilepsi ile duygudurum bozuklukları arasındaki ilişki, eştanı, ikincil durumlar ve her iki durumda tedavi seçenekleri ele alınmıştır.

Anahtar Kelimeler

Epilepsi, depresyon, bipolar bozukluk

Kaynakça

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• Sermin Kesebir, Doç. Dr., Erenköy Ruh ve Sinir Hastalıkları Hastanesi, İstanbul; Sertaç Güven, Dr., Erenköy
• Ruh ve Sinir Hastalıkları Hastanesi, İstanbul; İsmail Koç, Dr., Erenköy Ruh ve Sinir Hastalıkları Hastanesi, İstanbul