Selective Serotonin Reuptake Inhibitors: A Review of its Effects on Intraocular Pressure

Abstract

The increase in serotonin (5-HT) neurotransmission is considered to be one of the most efficacious medical approach to depression and its related disorders. The selective serotonin reuptake inhibitors (SSRIs) represent the most widely antidepressive drugs utilized in the medical treatment of depressed patients. Currently available SSRIs include fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram and escitalopram. The primary SSRIs pharmacological action’s mechanism consists in the presynaptic inhibition on the serotonin reuptake, with an increased availability of this amine into the synaptic cleft. Serotonin produces its effects as a consequence of interactions with appropriate receptors. Seven distinct families of 5-HT receptors have been identified (5-HT1 to 5-HT7), and subpopulations have been described for several of these. The interaction between serotonin and post-synaptic receptors mediates a wide range of functions. The SSRIs have a very favorable safety profile, although clinical signs of several unexpected pathologic events are often misdiagnosed, in particular, those regarding the eye. In all cases reported in the literature the angle-closure glaucoma represents the most important SSRIs-related ocular adverse event. Thus, it is not quite hazardous to hypothesize that also the other reported and unspecified visual disturbances could be attributed - at least in some cases - to IOP modifications. The knowledge of SSRIs individual tolerability, angle-closure predisposition and critical IOP could be important goals able to avoid further and more dangerous ocular side effects.

SSRI-associated optic neuropathy

“…3 A potential mechanism for ION has been previously described in relation to raised serotonin levels. 4,5 A single case of central retinal vein occlusion exists along with reports of deep vein thrombosis and ischaemic stroke. [6][7][8] Four out of five cases summarised in Table 1, presented with visual loss from suspected posterior ION (PION).…”

Effects of three months treatment with sertraline on intraocular pressure and cup-to-disc ratio in patients with anxiety disorders/mixed anxiety and depressive disorder/major depressive disorder and without underlying eye disease

“…In the present study, the mean sertraline dose was 95±2.5 mg daily. Previous studies have revealed (2,17,27,29,31)that the occurrence of this effect depends on the drug plasma level and its metabolites,occurring at a mean daily dose of SSRIs exceeding 20 mg(31) or ≥1 defined daily dose (17). In this study, we evaluated the effect of sertraline on the level of IOP and CDR in patients with anxiety disorders, mixed anxiety and depressive disorder, major depressive disorder.…”

“…It is widely used in treating patients with anxiety, depression, or other types of heterogenic mood disorders (1). In the last two decades, mood disorders have developed to an impressive extent and the prescription of SSRIs has increased because of its safety and tolerable profile in comparison with other antidepressant drugs (2)(3)(4)(5).Ocular complications of SSRIs are rarely detected and can be accompanied by dangerous consequences (6).Short-term SSRI exposure causes pupillary dilator muscle stimulation, active mydriasis, a sudden blockage of the drainage of aqueous humor fluid out of the eyes, a rapid rise in the intraocular pressure (IOP) level, damage to the optic nerve at the back of the eye,ultimately leading to acute angle closure glaucoma(AACG) (7). AACG is an ocular emergency and requires immediate treatment.…”

Keep an eye on the SSRI: help avoid possible sight-threatening adverse events

“…Costagliola et al described a mechanism for vasospasm in the optic nerve, postulating that increased plasma serotonin levels may be a factor, or a cofactor, in the development of optic nerve perfusion disorders. 3 In individuals with atherosclerotica the susceptibility becomes higher due to serotonin-enhancing platelet aggregation on atheromata of ocular arteries. 3,4 The most commonly-reported ophthalmic side effect of SSRIs is acute glaucoma.…”

“…3 In individuals with atherosclerotica the susceptibility becomes higher due to serotonin-enhancing platelet aggregation on atheromata of ocular arteries. 3,4 The most commonly-reported ophthalmic side effect of SSRIs is acute glaucoma. There is a single report of central retinal vein thrombosis in association with citalopram.…”