From the FDA Drug Label
Although anticonvulsant effects of citalopram have been observed in animal studies, citalopram tablets has not been systematically evaluated in patients with a seizure disorder. Duloxetine delayed-release capsules have not been systematically evaluated in patients with a seizure disorder, and such patients were excluded from clinical studies.
The FDA drug label does not answer the question.
From the Research
The recommended first-line treatment for a patient with major depressive disorder (MDD) and a history of seizures is typically a selective serotonin reuptake inhibitor (SSRI) such as sertraline or citalopram, due to their relatively low seizure risk and efficacy in treating depression symptoms, as supported by recent guidelines 1. When considering treatment options, it's essential to prioritize the patient's safety and well-being, taking into account their history of seizures and potential interactions with other medications.
- The treatment should start with a low dose and gradually increase to minimize side effects, with close monitoring, particularly during the first few weeks of treatment.
- Avoid bupropion, maprotiline, and clomipramine as they have higher seizure risks, as noted in studies 2, 3.
- Escitalopram and fluoxetine are also reasonable alternatives with low seizure potential, making them suitable options for patients with seizure disorders.
- Psychotherapy, particularly cognitive behavioral therapy (CBT), should be considered as an adjunctive treatment or alternative for patients with mild to moderate depression, as recommended by recent guidelines 1. The reason SSRIs are preferred is that they generally have a more favorable seizure threshold impact compared to tricyclic antidepressants or other classes, making them safer for patients with seizure disorders while still effectively treating depression symptoms, as discussed in studies 2, 4, 3.