Comment: The quality of evidence is downgraded by study quality (lack of allocation concealment), inconsistency (heterogeneity in patients, interventions and outcomes) and imprecise results (few studies for each comparison).
A Cochrane review included 8 studies (3 RCTs and 5 prospective cohort studies) studies with a total of 471 subjects. They had epilepsy and were treated with an antidepressant. Five studies included adults patients, 3 studies included both adults and children. Six studies included patients with focal onset epilepsy, and 2 studies included patients with generalised onset epilepsy. Seizure frequency data were not reported in any RCTs. Antidepressants (selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitor (SNRI) and tricyclic antidepressant) were compared with an active control, placebo or no treatment. Meta-analyses were not possible because the studies reported on different treatment comparisons. Venlafaxin showed efficacy in the outcome more than 50% reduction in depressive symptoms (RR 3.25, 1.19 to 8.9; one study, n=64), however, the study did not address the impact of seizure control on outcomes. Citalopram had a limited effect for the mean difference in depression score (RR 1.17, 95% CI 0.96 to 1.38; 2 studies, n=88). The results show that treatment in 3 studies with a SSRI did not significantly increase seizure frequency. Patients given an antidepressant were more likely to withdraw due to adverse events than inefficacy. Reported adverse events for SSRIs included nausea, dizziness, sedation, gastrointestinal disturbance and sexual dysfunction.
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