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. These patients were excluded from clinical studies during the product’s premarketing testing. In clinical trials of citalopram tablets, seizures occurred in 0. 3% of patients treated with citalopram tablets (a rate of one patient per 98 years of exposure) and 0. 5% of patients treated with placebo (a rate of one patient per 50 years of exposure). Like other antidepressants, citalopram tablets should be introduced with care in patients with a history of seizure disorder
The choice of antidepressant for patients with epilepsy should be made with caution.
- Citalopram may not be the best choice due to the lack of systematic evaluation in patients with seizure disorders.
- The risk of seizures is present, although the rate is relatively low (0.3% in clinical trials).
- Patients with a history of seizure disorder should be introduced to citalopram with care. No clear ranking can be made based on the available information, and the decision should be made on a case-by-case basis, considering the individual patient's circumstances and medical history 1.
From the Research
When selecting antidepressants for patients with epilepsy, selective serotonin reuptake inhibitors (SSRIs) are generally the first-line choice due to their favorable seizure risk profile, as supported by the most recent study 2. The choice of antidepressant should be individualized based on the patient's seizure control, comorbidities, and potential drug interactions with antiepileptic medications. Some key points to consider when selecting an antidepressant for patients with epilepsy include:
- SSRIs, such as sertraline, citalopram, and escitalopram, are preferred options due to their minimal impact on seizure threshold 3, 2.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine and duloxetine can be considered as second-line options, with a moderate seizure risk 3, 2.
- Mirtazapine and bupropion can be considered as alternatives with careful monitoring, although bupropion has been associated with a higher risk of seizures 2.
- Tricyclic antidepressants (TCAs) like amitriptyline and nortriptyline should be used with significant caution due to their higher seizure risk, particularly at doses above 200mg daily 3, 2.
- Monoamine oxidase inhibitors (MAOIs) should generally be avoided due to their potential interactions with other medications and higher risk of seizures. Starting at lower doses and titrating slowly is recommended, with close monitoring for any changes in seizure frequency or severity, as suggested by studies 4, 5. It is essential to weigh the benefits and risks of each antidepressant and consider the individual patient's needs and medical history when making a treatment decision, as emphasized by the study 6. Ultimately, the goal is to select an antidepressant that effectively manages the patient's depressive symptoms while minimizing the risk of seizures and other adverse effects, as highlighted by the most recent study 2.