Effect Of Agomelatine On Depression And Seizure In Patients With Epilepsy And Depressive Disorder

PurposeA retrospective analysis was conducted in patients with epilepsy complicated with depressive disorder,and the common clinical manifestations were summarized.The efficacy of agomelatine in improving depression in these patients,its influence on epileptic seizure and its safety were discussed and evaluated.To provide help for medical workers to identify epilepsy patients with depressive disorder and select appropriate drugs.MethodFrom March 2021 to August 2022,patients who were diagnosed with epilepsy combined with depressive disorder and only treated with agomelatine(AGO)or escitalopram(ESC)as antidepressants in the Department of Neurology,Qilu Hospital of Shandong University were included.Demographic data(age,gender),clinical data(past medical history,course of epilepsy,etiology of seizures,type of seizures,frequency of seizures,use of antiseizure medications(ASMs),adverse reactions during treatment),laboratory tests(blood routine,liver function,renal function before treatment and 8 weeks or more after treatment)and Hamilton depression scale(HAMD)scores before treatment and 8 weeks or more after treatment were collected.According to the antidepressant regimen,the patients were divided into agomelatine group and escitalopram group.T test and nonparametric test were used to analyze HAMD score and HAMD score reduction rate,nonparametric test was used to analyze seizure frequency and seizure reduction rate,and Chi-square test was used to analyze the incidence of adverse reactions,so as to analyze whether there were differences between the two groups of patients in antidepressant efficacy,influence on seizures,and safety.ResultA total of 106 patients were included and finally completed the retrospective analysis,including 45 cases in the agomelatine group and 61 cases in the Escitalopram group.The most common clinical manifestations assessed by the HAMD scale in patients with epilepsy and depressive disorder were sleep disorders,including difficulty in falling asleep,lack of sleep,and early awakening,accounting for 83.0%,80.2%,and 77.4%,followed by depression,accounting for 76.4%.The other common clinical manifestations were retardation,mental anxiety,somatic anxiety,hypochondria,work and interest,accounting for more than 50%.The HAMD scores of agomelatine group before and after treatment were 18.36±5.985 and 9.49±3.964 respectively,and the effective rate was 77.8%.The HAMD scores of escitalopram group before and after treatment were 17.33±5.322 and 9.26±5.160 respectively,and the effective rate was 77.0%.The HAMD scores of the two groups after treatment were significantly lower than those before treatment(P<0.001),but there was no significant difference in HAMD score and effective rate between the two groups(P>0.05).The correlation analysis of antidepressant efficacy in patients with agomelatine alone showed that there was a significant negative correlation between the course of epilepsy,the number of ASMs and the reduction rate of HAMD score(P<0.01).In the agomelatine group,the average seizure frequency was 2(2,4)times/month before treatment and 1(0,2)times/month after treatment.The total effective rate was 66.7%,of which 21 cases were markedly effective(46.7%),9 cases were effective(20.0%),15 cases were ineffective(33.3%).,and 0 case(0.0%)was aggravated.In the escitalopram group,the average seizure frequency was 3(2,4)times/month before treatment and 2(1,3)times/month after treatment.The total effective rate of 47.5%,of which 16 cases(26.2%)were markedly effective,13 cases(21.3%)were effective,32 cases(52.5%)were ineffective,and 0 case(0.0%)was aggravated.The comparison between groups showed that the frequency of seizures in the agomelatine group was significantly lower than that in the escitalopram group after treatment,and there was a statistical difference between the two groups(P<0.05).The reduction rate of seizures in the agomelatine group was significantly higher than that in the escitalopram group(P<0.05).The clinical efficacy of agomelatine group was significantly higher than that of escitalopram group(P<0.05).No major adverse events occurred in both groups.The total incidence of adverse reactions was 15.6%in the agomelatine group and 14.8%in the escitalopram group.There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Blood routine,liver function and renal function tests were performed in both groups,and no obvious abnormalities were found.Conclusion1.The most common clinical manifestations in patients with epilepsy and depressive disorder are sleep disorders,including difficulty in falling asleep,lack of sleep,and early awakening,followed by depression.2.In patients with epilepsy and depressive disorder,agomelatine and escitalopram can both improve depression,and there is no difference in antidepressant efficacy between the two drugs.;3.In patients with epilepsy and depressive disorder,agomelatine combined with antiseizure medications can reduce the frequency of seizures to a greater extent than escitalopram combined with antiseizure medications.4.In patients with epilepsy and depressive disorder,the adverse reactions of agomelatine and escitalopram were mild,and there was no difference in adverse reactions between the two groups.