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 [Abstract] 1 included 4 RCTs and 6 prospective non-randomised studies of interventions (NRSIs)with a total of 626 subjects. They had epilepsy and were treated with an antidepressant. One RCT was a multi-centre study comparing an antidepressant with cognitive behavioural therapy (CBT). The other three RCTs were single-centre studies comparing an antidepressant with an active control, placebo, or no treatment. The NRSIs reported on outcomes mainly in participants with focal epilepsy before and after treatment for depression with a selective serotonin reuptake inhibitor (SSRI).
More than 50% improvement in depressive symptoms ranged from 43% to 82% in RCTs, and from 24% to 97% in NRSIs, depending on the antidepressant given. Venlafaxine improved depressive symptoms by more than 50% compared to no treatment (mean difference (MD) -7.59 (95% confidence interval (CI) -11.52 to -3.66; 1 study, n=64); the results between other comparisons were inconclusive. Seizure frequency data did not suggest an increased risk of seizures with antidepressants compared to control treatments or baseline. Two studies measured quality of life; antidepressants did not appear to improve quality of life over control treatments or baseline.
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