{"title":"慢性肝病和抑郁症患者服用抗抑郁药:何时需要使用抗抑郁药,如何选择合适的药物?","authors":"Swapnajeet Sahoo , Eepsita Mishra , Madhumita Premkumar","doi":"10.1016/j.jceh.2024.101390","DOIUrl":null,"url":null,"abstract":"<div><p>Most chronic medical illnesses are associated with significant psychiatric comorbidity, especially in the form of depression, anxiety, and suicidality. Chronic liver disease (CLD) is no exception to this and rather is placed uniquely as compared to other diseases because of its intersection with alcohol use disorder and other substance use, which in itself is a mental illness. Patients with CLD may have comorbid psychiatric illnesses; the pharmacokinetic concerns arising out of hepatic dysfunction which affects pharmacotherapy for depression and vice versa. The high prevalence of medical comorbidities with CLD may further complicate the course and outcome of depression in such patients, and diagnostic and management issues arise from special situations like transplant evaluation, alcohol use disorder, and hepatic encephalopathy or multifactorial encephalopathy seen in a disoriented or agitated patient with CLD. For this narrative review, we carried out a literature search in PubMed/PubMed Central and in Google Scholar (1980–2023) with the keywords “depression in cirrhosis”, “antidepressants in liver disease”, “anxiety in liver disease”, “depression in liver transplantation”, and “drug interactions with antidepressants”. This review presents a comprehensive view of the available research on the use of antidepressants in patients with CLD, including deciding to use them, choosing the right antidepressant, risks, drug interactions, and adverse reactions to expect, and managing the same. In addition, liver transplant fitness and the overlap of hepatic encephalopathy with neuropsychiatric illness will be discussed.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3000,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Antidepressants in People With Chronic Liver Disease and Depression: When Are They Warranted and How to Choose the Suitable One?\",\"authors\":\"Swapnajeet Sahoo , Eepsita Mishra , Madhumita Premkumar\",\"doi\":\"10.1016/j.jceh.2024.101390\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>Most chronic medical illnesses are associated with significant psychiatric comorbidity, especially in the form of depression, anxiety, and suicidality. Chronic liver disease (CLD) is no exception to this and rather is placed uniquely as compared to other diseases because of its intersection with alcohol use disorder and other substance use, which in itself is a mental illness. Patients with CLD may have comorbid psychiatric illnesses; the pharmacokinetic concerns arising out of hepatic dysfunction which affects pharmacotherapy for depression and vice versa. The high prevalence of medical comorbidities with CLD may further complicate the course and outcome of depression in such patients, and diagnostic and management issues arise from special situations like transplant evaluation, alcohol use disorder, and hepatic encephalopathy or multifactorial encephalopathy seen in a disoriented or agitated patient with CLD. For this narrative review, we carried out a literature search in PubMed/PubMed Central and in Google Scholar (1980–2023) with the keywords “depression in cirrhosis”, “antidepressants in liver disease”, “anxiety in liver disease”, “depression in liver transplantation”, and “drug interactions with antidepressants”. This review presents a comprehensive view of the available research on the use of antidepressants in patients with CLD, including deciding to use them, choosing the right antidepressant, risks, drug interactions, and adverse reactions to expect, and managing the same. In addition, liver transplant fitness and the overlap of hepatic encephalopathy with neuropsychiatric illness will be discussed.</p></div>\",\"PeriodicalId\":15479,\"journal\":{\"name\":\"Journal of Clinical and Experimental Hepatology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2024-02-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical and Experimental Hepatology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0973688324000471\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical and Experimental Hepatology","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0973688324000471","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
大多数慢性内科疾病都与严重的精神并发症有关,尤其是抑郁、焦虑和自杀。慢性肝病(CLD)也不例外,与其他疾病相比,慢性肝病具有独特性,因为它与酒精使用障碍和其他药物使用有交叉,而酒精使用障碍和其他药物使用本身就是一种精神疾病。CLD 患者可能合并有精神疾病;肝功能障碍引起的药代动力学问题会影响抑郁症的药物治疗,反之亦然。CLD患者合并内科疾病的高发率可能会使这类患者的抑郁过程和结果更加复杂,而特殊情况下的诊断和管理问题也会随之而来,如移植评估、酒精使用障碍、肝性脑病或多因素脑病等,这些都会在神志不清或躁动不安的CLD患者身上出现。为了撰写这篇叙事性综述,我们在 PubMed/PubMed Central 和 Google Scholar 中进行了文献检索(1980-2023 年),关键词为 "肝硬化中的抑郁"、"肝病中的抗抑郁药"、"肝病中的焦虑"、"肝移植中的抑郁 "和 "抗抑郁药的药物相互作用"。这篇综述全面介绍了关于在慢性肝病患者中使用抗抑郁药的现有研究,包括决定使用抗抑郁药、选择合适的抗抑郁药、风险、药物相互作用、预期的不良反应以及处理这些不良反应。此外,还将讨论肝移植适应症以及肝性脑病与神经精神疾病的重叠问题。
Antidepressants in People With Chronic Liver Disease and Depression: When Are They Warranted and How to Choose the Suitable One?
Most chronic medical illnesses are associated with significant psychiatric comorbidity, especially in the form of depression, anxiety, and suicidality. Chronic liver disease (CLD) is no exception to this and rather is placed uniquely as compared to other diseases because of its intersection with alcohol use disorder and other substance use, which in itself is a mental illness. Patients with CLD may have comorbid psychiatric illnesses; the pharmacokinetic concerns arising out of hepatic dysfunction which affects pharmacotherapy for depression and vice versa. The high prevalence of medical comorbidities with CLD may further complicate the course and outcome of depression in such patients, and diagnostic and management issues arise from special situations like transplant evaluation, alcohol use disorder, and hepatic encephalopathy or multifactorial encephalopathy seen in a disoriented or agitated patient with CLD. For this narrative review, we carried out a literature search in PubMed/PubMed Central and in Google Scholar (1980–2023) with the keywords “depression in cirrhosis”, “antidepressants in liver disease”, “anxiety in liver disease”, “depression in liver transplantation”, and “drug interactions with antidepressants”. This review presents a comprehensive view of the available research on the use of antidepressants in patients with CLD, including deciding to use them, choosing the right antidepressant, risks, drug interactions, and adverse reactions to expect, and managing the same. In addition, liver transplant fitness and the overlap of hepatic encephalopathy with neuropsychiatric illness will be discussed.