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September 2010

Personalized Medicine
Even before genomic advances are ready for clinical use, "low-tech" aspects of personalized medicine can enhance psychiatric treatment.

Treating Patients with Schizophrenia: The Importance of Adherence
Antipsychotics can't work if patients don't take them. Nonadherance is a major cause of relapse among patients with schizophrenia.

Valproic Acid and Congenital Malformation
Exposure to valproic acid in the first trimester of pregnancy increases the risk of many congenital malformations in newborns.

In Brief
Bone Mineral Density Is Lower in Depressed than Nondepressed People; Few Adolescents Who Die by Suicide Have Had Recent Exposure to SSRIs

IV Ketamine Infusion Decreases Suicidal Ideation
In a study of treatment-resistant inpatients with major depressive disorder, a single IV infusion of ketamine rapidly decreased suicidal ideation.

SSRIs May Increase the Risk of Cataracts
In a pharmacoepidemiologic study, the use of selective serotonin reuptake inhibitor (SSRI) antidepressants was associated with a greater risk of cataracts among elderly patients.

SSRIs May Increase the Risk of Cataracts

September 2010

Cataracts are the world's leading cause of blindness.1 Some drugs, like systemic steroids, are known to increase the risk of cataracts. Whether antidepressants similarly elevate this risk is less clear,1 but serotonin can increase lens opacity and cause cataracts in animals. This fact led Etminan and coworkers to conduct a pharmacoepidemiologic study in seniors.1

Using an administrative data set in Quebec, the authors assessed 18,784 patients, aged 65 years or older (mean age, 73 years), who had undergone coronary revascularization between 1995 and 2004. Each patient who subsequently developed cataracts was matched with 10 control subjects by index date, age, and cohort entry.

As found in previous studies, the risk of developing cataracts was higher among women and in patients who used antidiabetics or corticosteroids or had a history of hypertension. Even when investigators controlled for other risk factors, the current use of selective serotonin reuptake inhibitor (SSRI) antidepressants also increased the risk of developing cataracts—by roughly 15%. Differences observed among antidepressants were nonsignificant. On average, patients received a first diagnosis of cataract after 656 days of SSRI therapy. Past users of antidepressants did not appear to be at increased risk.

Case-control studies, such as this one, suggest associations, but do not prove cause and effect. An associated risk factor, such as smoking, which is more prevalent in people who suffer from depression, could account for the increased cataract risk rather than the antidepressants. Nonetheless, we are left with a few facts: Cataracts are common and can cause blindness. Depression also is common, and so is the use of antidepressant medications. Patients who have depression deserve increased attention to their physical health. Screening for cataracts should be included.

Our thanks to Chittaranjan Andrade, MD, whose article on this topic in his newsletter, Synergy Times, inspired this piece.

1Etminan M, Mikelberg FS, Brophy JM: Selective serotonin reuptake inhibitors and the risk of cataracts: A nested case-control study. Ophthalmology 2010;117:1251–1255.