A Review of Ocular Complications Associated with Medications Used for Anxiety, Depression, and Stress

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Table 1 Common Therapeutics Used in the Treatment and Management of Anxiety, Depression, and Stress

Drug Class	Name	Therapeutic Indication
Tricyclic antidepressants	Amitriptyline (Endep, Entrip)	Severe depression, neuropathic pain, post-traumatic stress disorder
	Clomipramine (Anafranil, Placil)	Severe depression, obsessive compulsive disorder, phobias, panic disorders
	Doxepin (Deptran, Sinequan)	Severe depression, neuropathic pain, obsessive compulsive disorder, panic disorder, generalized anxiety disorder, phobias, post-traumatic stress disorder
	Nortriptyline (Allegron, NortriTABS)	Severe depression, neuropathic pain
	Imipramine (Tofranil, Tolerade)	Severe depression, generalized anxiety disorder, panic disorder
	Dosulepin/dothiepin (Dothep)	Severe depression with anxiety
Monoamine oxidase inhibitors	Tranylcypromine (Parnate)	Major depressive disorders, some anxiety disorders including phobic and panic disorders
	Moclobemide (Reversible inhibitor of Monoamine oxidase)	Depressive disorders, panic disorders
	Phenelzine (Nardil)	Depression
SSRIs	Citalopram (Celapram, Celica, Cipramil, Talam)	Major depressive disorders, generalized anxiety disorder, bipolar depression, obsessive compulsive disorder, panic disorders, post-traumatic stress disorder, social phobia
	Fluoxetine (Fluotex, Lovan, Prozac, Prozet, Zactin)
	Fluvoxamine (Facerin, Luvox, Movox, Voxam)
	Paroxetine (Aropax, Extine, Paxtine, Roxet, Roxtine)
	Sertraline (Eleva, Sertra, Sertracor, Setrona, Xydep, Zoloft)
	Escitalopram (Lexapro)
SNRIs	Venlafaxine (Altven, Efexor-XR, Elaxine, Enlafax-XR)	Major depression, generalized anxiety disorder, panic disorder, social anxiety disorder
	Desvenlafaxine (Desfax, Desven, Pristiq)	Major depression
	Duloxetine (Andepra, Coperin, Cymbalta, Depreta, Dytrex, Tixol)	Major depression, generalized anxiety disorder, neuropathic pain
Benzodiazepines	Temazepam (Euhypnos, Normison)	Short-term insomnia
	Nitrazepam (Alodorm, Mogadon)	Insomnia
	Diazepam (Valium, Ducene)	Short-term management of anxiety and agitation
	Oxazepam (Alepam, Murelax, Serepax)	Anxiety
	Alprazolam (Xanax)	Anxiety, panic disorder
	Lorazepam (Ativan)	Anxiety, and short-term treatment of insomnia
Typical antipsychotics	Risperidone (Risperdal, Rispa, Rixadone)	Schizophrenia and related psychoses, short-term treatment of acute mania associated with bipolar disorder
	Aripiprazole (Abilify, Abyraz)	Schizophrenia, bipolar disorder
	Clozapine (Clozaril)	Schizophrenia
	Olanzapine (Zyprexa, Pryzex)	Schizophrenia and related psychoses, short-term treatment of acute mania associated with bipolar disorder
	Quetiapine (Seroquel, Syquet, Quetia XR, Tevatiapine XR)	Bipolar disorder
	Ziprasidone (Zeldox, Ziprox)	Schizophrenia and related psychoses, short-term treatment of acute mania associated with bipolar disorder
Gamma-aminobutyric acid analogues	Pregabalin (Lyrica)	Epilepsy, neuropathic pain
	Gabapentin (Aspen)	Epilepsy, neuropathic pain, off-label anxiolytic for panic disorders

Table 2 Common Ocular Side Effects Associated with Therapeutics Used for the Treatment and Management of Depression, Anxiety, and Stress

Drug Class	Name	Ocular Side Effect
Tricyclic antidepressants	Chlorpromazine	Decreased lacrimation and dry eye, mydriasis, cataracts, blurred vision, corneal oedema, corneal epithelial keratopathy, abnormal pigmentation of the eyelids/conjunctiva/cornea/peripheral retina^Citation2
	Amitriptyline (Endep, Entrip)	Decreased lacrimation and dry eye, mydriasis, blurred vision, cataracts, acute angle closure due to pupil block (amitriptyline, imipramine)
	Clomipramine (Anafranil, Placil)
	Doxepin (Deptran, Sinequan)
	Nortriptyline (Allegron, NortriTABS)
	Imipramine (Tofranil, Tolerade)
	Dosulepin/dothiepin (Dothep)
Monoamine oxidase inhibitors	Tranylcypromine (Parnate)	Blurred vision Rare: occipital headache, ping-pong gaze (phenelzine)
	Moclobemide (Reversible inhibitor of Monoamine oxidase)
	Phenelzine (Nardil)
SSRIs	Citalopram (Celapram, Celica, Cipramil, Talam)	Dry eye, mydriasis, intraocular pressure elevation, acute angle closure crisis Rare: ocular dystonia, oculogyric crisis, diplopia, optic neuropathy, maculopathy (sertraline), eyelash loss (escitalopram)
	Escitalopram (Lexapro)
	Fluoxetine (Fluotex, Lovan, Prozac, Prozet, Zactin)
	Fluvoxamine (Facerin, Luvox, Movox, Voxam)
	Sertraline (Eleva, Sertra, Sertracor, Setrona, Xydep, Zoloft)
	Paroxetine (Aropax, Extine, Paxtine, Roxet, Roxtine)
SNRIs	Venlafaxine (Altven, Efexor-XR, Elaxine, Enlafax-XR)	Dry eye, blurred vision, mydriasis, shallow anterior chamber depth, cataracts, intraocular pressure depression, acute angle-closure crisis (venlafaxine, duloxetine) Rare: retrobulbar optic neuritis (duloxetine), pendular nystagmus (venlafaxine)
	Desvenlafaxine (Desfax, Desven, Pristiq)
	Duloxetine (Andepra, Coperin, Cymbalta, Depreta, Dytrex, Tixol)
Benzodiazepines	Lorazepam (Ativan)	Blurred vision, increased risk of bilateral acute angle closure Rare: impaired tracking (alprazolam), diplopia (lorazepam)
	Temazepam (Euhypnos, Normison)
	Nitrazepam (Alodorm, Mogadon)
	Diazepam (Valium, Ducene)
	Oxazepam (Alepam, Murelax, Serepax)
	Alprazolam (Xanax)
Atypical antipsychotics	Risperidone (Risperdal, Rispa, Rixadone)	Blurred vision, mydriasis, decreased lacrimation (clozapine), cataracts (quetiapine) Rare: floppy iris syndrome, oculogyric crisis
	Aripiprazole (Abilify, Abyraz)
	Clozapine (Clozaril)
	Olanzapine (Zyprexa, Pryzex)
	Quetiapine (Seroquel, Syquet, Quetia XR, Tevatiapine XR)
	Ziprasidone (Zeldox, Ziprox)
Gamma-aminobutyric acid analogues	Pregabalin (Lyrica)	Blurry vision, diplopia Rare: bilateral macular detachment, visual hallucinations
	Gabapentin (Aspen)	Nystagmus, increased risk of angle closure glaucoma

Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395:912–920.

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