Has glaucoma been reported as a side effect of treatment with different SSRI´s or new antidepressan

Fråga: Has glaucoma been reported as a side effect of treatment with different SSRI´s or new antidepressants such as venlafaxine or nefazodone?

Background: A 65-year-old woman with depression is treated with Timolol (eyedrops) because of primary glaucoma.

Treatment with citalopram for three months resulted in a two-fold intraocular pressure increase. Treatment with citalopram was therefore stopped. Two weeks after the treatment was stopped the intraocular pressure was normalized.

The patient has previously been treated with clomipramine. However, the clinical effect was inadequate.

Sammanfattning: Although no data are available on treatment with the selective serotonine reuptake inhibitors, nefazodone or venlafaxine, and the risk of provoking glaucoma attacks, it seems likely that tricyclic antidepressants are more likely to trigger attacks of glaucoma due to the known anticholinergic effects. However the lack of information considering anticholinergic effects of the SSRI´s, nefazodone and venlafaxine should be considered before using these drugs. In the present case one of the new antidepressants eg venlafaxine could be tried. Control of the intraocular pressure before and initially after treatment has been started is recommended. Patients with a history of glaucoma should have regular controls of the intraocular pressure when being treated with antidepressants.

Svar: A question concerning the risk of developing glaucoma due to treatment with different tricyclic antidepressants has been answered in Drugline before (1). Anticholinergic side-effects are known to cause dilatation of the pupil and may trigger attacks of a narrow-angle glaucoma. Comparative data suggest more anticholinergic effects for amitriptyline and imipramine and less for desipramine, nortriptyline and protriptyline (1).

Although selective serotonine reuptake inhibitors as well as nefazodone and venlafaxine have no or weak anticholinergic effects according to (2) several side effects eg disturbances of accommodation and micturition appear to be anticholinergic.

A search in Medline revealed only a case report on glaucoma induced by fluoxetine (3). This patient experienced several symptoms related to anticholinergic effects after five weeks of treatment. After withdrawal of fluoxetine, the symptoms disappeared within 48 hours. The file of SADRAC contains no reports on other SSRI´s, nefazodone or venlafaxine in connection with glaucoma.

We recommend this case be reported to the regional center of SADRAC. 1 Drugline nr 05636 (year 1987) (enclosed) 2 FASS 1996 3 Ahmad S: Fluoxetine and glaucoma. (letters) DICP 1991; 25: 436