Antidepressants for people with epilepsy and depression

Area of Science:

• Neurology
• Psychiatry
• Clinical Pharmacology

Background:

• Depression is a common comorbidity in epilepsy patients, impacting quality of life.
• Uncertainty exists regarding optimal antidepressant treatment and seizure exacerbation risks.

Purpose of the Study:

• To review and synthesize evidence on antidepressant efficacy and safety in epilepsy patients with depression.
• To evaluate the impact of antidepressants on depressive symptoms and seizure recurrence.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) and prospective non-randomized studies.
• Searched multiple databases up to May 2014, including Cochrane, MEDLINE, SCOPUS, PsycINFO.
• Extracted data on depression scores, seizure frequency, withdrawals, and adverse events.

Main Results:

• Eight studies (3 RCTs, 5 cohort) involving 471 patients were included; risk of bias was mostly unclear or high.
• Varied antidepressant responder rates (24-97%); limited meta-analysis showed low-quality evidence for citalopram.
• Selective serotonin reuptake inhibitors (SSRIs) did not significantly increase seizure frequency; adverse events common.

Conclusions:

• Existing evidence on antidepressant effectiveness for epilepsy-associated depression is very limited.
• No high-quality evidence supports specific antidepressant choices; low-quality evidence suggests SSRI safety regarding seizures.
• Further comparative trials of antidepressants and psychotherapy are needed.