SSRIs May Boost Risk for Cataracts

Caroline Cassels

March 19, 2010

March 19, 2010 — Just like older-generation antidepressants, selective serotonin reuptake inhibitors (SSRIs) have been associated with an increased risk for cataracts, new research shows.

Investigators at the Center for Clinical Epidemiology and Evaluation at the Vancouver Coastal Health Research Institute in Canada found that as a drug class SSRIs are associated with an overall 15% increase in cataract risk but that some agents — fluvoxamine in particular — were associated with a higher risk.

"As a drug class we found SSRIs were associated with a slight increase in the relative risk. But when we looked at individual agents we found the risk differs from one drug to another," principal investigator Mahyar Etminan, PharmD, MSc, told Medscape Psychiatry.

"However, based on this study alone, I would not advocate that individuals should switch from one agent ot another. Nonetheless, it is an interesting observation that should be looked at in future studies," Dr. Etminan added.

The study was published online March 7 in Ophthalmology.

Although animal studies have suggested a potential link between SSRIs and the development of cataracts, there have been no large population-based studies examining this association.

"We wanted to look into this potential risk that was seen in the older-generation drugs to see whether the newer class of antidepressants also increased risk," said Dr. Etminan.

The nested case-control study included 206,624 subjects who had received coronary revascularization between 1995 and 2004 in the province of Quebec. Cases were defined as those with a first diagnosis of a cataract diagnosed by an ophthalmologist. For each case, there were 10 matched controls.

Crude and adjusted rate ratios (RRs) and corresponding confidence intervals (CIs) were computed for current use of SSRIs. The RRs were adjusted for sex, corticosteroid used, statins, high blood pressure, antihypertensives, and antidiabetics.

In total there were 18,784 cases and 187,840 controls. The adjusted RR for cataracts among current users of SSRIs was 1.15 (95% CI, 1.08 – 1.23).

With a RR of 1.39 (95% CI, 1.07 – 1.80) fluvoxamine had the highest cataracts risk. This was followed by venlafaxine (RR, 1.33; 95% CI, 1.14 – 1.55) and paroxetine (RR, 1.23; 95% CI, 1.05 – 1.45). The average time for the diagnosis of cataracts while receiving SSRI treatment was 656 days.

The study authors point out that although citalopram, fluoxetine, and sertraline did not show a statistically significant increase in the risk for cataracts, the study may have been underpowered to assess the association with all individual antidepressants.

According to Dr. Etminan, this study is the first to show that SSRI use may be associated with an increased risk for cataracts.

Given the relatively low risk for cataracts associated with SSRIs as a class, Dr. Etminan said he would not recommend patients stop taking antidepressants or chose one agent over another based on a potential risk for cataracts.

Further research with larger numbers of patients is required before any definitive clinical recommendations are warranted. In the meantime, he said, patients should seek an ophthalmologist's advice if they experience any change in their vision.

"Patients also need to keep in mind that cataracts are really quite benign, and cataract surgery is probably one of the safest surgeries we have," he said.

The study authors have disclosed no relevant financial relationships.

Ophthalmology. Published online March 7, 2010.