Summary of findings 4.

Citalopram (before and after) for people with epilepsy and depression

Citalopram (before and after) for people with epilepsy and depression
Patient or population: people with epilepsy and depression Settings: outpatients Intervention: citalopram (before and after)
Outcomes	Illustrative comparative risks* (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Corresponding risk
	Citalopram (before and after)
Mean depression scores ‐ HAMD	The mean HAMD depression score in the intervention groups was 1.17 higher (0.96 to 1.38 higher)	88 (2 studies)	⊕⊕⊝⊝ low1,2	2 before and after studies investigated citalopram and found that depression scores were significantly lower after treatment
Mean monthly seizure frequency		88 (2 studies)	⊕⊝⊝⊝ very low1,3	2 studies found mixed evidence for the effect of citalopram on seizure frequency. Due to high heterogeneity the overall effect estimate is not presented
*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; HAMD: Hamilton Rating Scale for Depression
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

¹Across the studies there were concerns about bias with regards to the methods of blinding and methods to deal with confounding variables. ²Large effect found. ³Statistical heterogeneity was significant (P = 0.02; I² = 81%).