. 2021 Apr 16;2021(4):CD010682. doi: 10.1002/14651858.CD010682.pub3

Summary of findings 5. Citalopram (before and after treatment) for people with epilepsy and depression.

Citalopram (before and after treatment) for people with epilepsy and depression
Patient or population: people with epilepsy and depression Settings: outpatients Intervention: citalopram Control: before citalopram treatment
Outcomes	*Illustrative comparative risks (95% CI)**	No of participants (studies)	Certainty of the evidence (GRADE)	Comments
Outcomes	Citalopram (before and after)	No of participants (studies)	Certainty of the evidence (GRADE)	Comments
> 50% reduction in depressive symptoms Follow‐up: 4 months	11 out of 45 participants (24%) showed a 50% or more improvement in depression scores after treatment compared to baseline.	45 (1 NRSI)	⊕⊕⊝⊝ low^a
Mean depression scores (HAMD scores; lower = better) Follow‐up: 8 weeks to 4 months	Improved depression scores were shown after citalopram compared to before (see comment)	88 (2 NRSI)	⊕⊕⊝⊝ low^a^,b,c	SMD in HAMD score was 1.17 (95% CI 0.96 to 1.38), indicating improved outcomes and a large treatment effect.
Seizure frequency Follow‐up: 8 weeks to 4 months	See comment	88 (2 NRSI)	⊕⊝⊝⊝ very low^a^,c	Results were mixed between studies; due to very high heterogeneity (I² = 81%), we did not present the overall effect estimate.
Withdrawals Follow‐up: 8 weeks to 4 months	6/45 participants (13%) withdrew from one study; 0/43 from the other study	88 (2 NRSI)	⊕⊕⊝⊝ low^a
Cognitive functioning Follow‐up: NA	‐	0 (0 studies)	‐
Quality of life Follow‐up: NA	‐	0 (0 studies)	‐
Adverse effects Follow‐up: 8 weeks to 4 months	22/45 participants (56%) experienced adverse events in one study; 5/43 (12%) in the other study	88 (2 NRSI)	⊕⊕⊝⊝ low^a	Specific adverse events reported: nausea, sexual dysfunction, headache, dizziness, drowsiness, and fatigue
CI: confidence interval; HAMD: Hamilton Rating Scale for Depression; NRSI: non‐randomised studies of interventions
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 twice as studies were judged to be at serious risk of bias due to lack of blinding, which may have influenced participant‐recorded outcomes, and lack of adjustment for confounding variables.  ^bCertainty of the evidence upgraded once as large effect found. ^cCertainty of the evidence downgraded due to inconsistency: substantial statistical heterogeneity was present (I² > 50%).