Summary of findings 1. Paroxetine compared to doxepin for people with epilepsy and depression.
| Paroxetine compared to doxepin for people with epilepsy and depression | ||||||
| Patient or population: people with epilepsy and depression Settings: outpatients Intervention: paroxetine Comparison: doxepin | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| doxepin | paroxetine | |||||
|
> 50% reduction in depressive symptoms Follow‐up: 8 weeks |
706 per 1000 | 819 per 1000 (621 to 1000) | RR 1.16 (0.88 to 1.52) | 67 (1 RCT) | ⊕⊕⊕⊝ moderatea | |
|
Mean depression scores (HAMD scores; lower = better) Follow‐up: 8 weeks |
NA | The mean HAMD depression score in the intervention groups was 0.65 higher (2.15 lower to 3.45 higher) | NA | 67 (1 RCT) | ⊕⊕⊕⊝ moderatea | |
|
Seizure frequency Follow‐up: NA |
‐ | ‐ | ‐ | 0 (0 studies) |
‐ | |
|
Withdrawals Follow‐up: 8 weeks |
88 per 1000 | 13 per 1000 (1 to 242) | RR 0.15 (0.01 to 2.74) | 67 (1 RCT) | ⊕⊕⊕⊝ moderatea |
doxepin: 3 withdrew paroxetine: 0 withdrew |
|
Cognitive functioning Follow‐up: NA |
‐ | ‐ | ‐ | 0 (0 studies) |
‐ | |
|
Quality of life Follow‐up: NA |
‐ | ‐ | ‐ | 0 (0 studies) |
‐ | |
|
Adverse effects Follow‐up: 8 weeks |
Reported adverse events: blurred vision, dizziness, dry mouth, sleep disorders, and urinary retention | Reported adverse events: blurred vision, dizziness, dry mouth, and sleep disorders | NA | 67 (1 RCT) |
⊕⊕⊕⊝ moderatea |
There were no significant differences between treatment groups for any reported adverse events |
| *The basis for the assumed risk is the event rate in the doxepin group. 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; NA: not applicable; RCT: randomised controlled trial; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty. Further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty, Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty. 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 certainty. We are very uncertain about the estimate. | ||||||
aCertainty of the evidence downgraded for imprecision, because only one small study contributed to the outcomes.