Antidepressants-a possibly risk factor for cataract development: a cross-sectional study

Rajnish Raj, Anuradha Raj, Rohit Garg


Background: Few studies have reported the role of antidepressants as cataractogenic in humans.

Methods: It’s a hospital based descriptive, cross-sectional study. 45 Patients were screened for antidepressant use and diminution of vision, 6 were dropped out. 39 patients with 78 eyes were finally enrolled. They were divided into two goups i.e., Group-I, with cataract (N=53) and Group-II, without cataract (N=25). Three clusters of antidepressants were assessed e.g., SSRI, SNRI and TCA with therapeutic dose (TD) and non-therapeutic dose (NTD) range. Psychiatric illness was diagnosed on DSM-5 and severity of depression on HAM-D. Best corrected visual acuity (BCVA) was converted from Snellen units to logarithm of minimal angle of resolution (log MAR) for statistical analysis. Cataract changes in eyes were seen on slit-lamp and classified on Lens opacities classification system-III (LOCS-III) criteria.

Results: A total 78 eyes of thirty-nine (39) patients were evaluated. Thirty (38.46%) and forty-eight (61.53%) eyes belonged to males and females, respectively. Mean age of males (n=7) was 41.8±2.3 years and females (n=32) 40.2±1.0 years. In Group-I, out of (N=53) eyes that developed cataract 33 were females (62.26%) as compared to males 20 (37.7%). Group -II, out of (N=25) eyes, females without cataract were 15 (60%) as compared to males 10 (40%).  Therapeutic dose (TD) of antidepressants (AD) in Group-I had more cataract 37 (69.81%) as compared to non-therapeutic dose (NTD) 16 (30.1%). Most of the eyes with cataract 35 (66.03%) had AD exposure of more than 1 year that was possibly associated with increased risk of cataract development (OR 2.10; 95% CI, 0.79-5.55). Amongst users of antidepressants, SSRI was associated with increased risk of cataract development (OR 2.4; 95% CI, 0.72–7.94) with a female preponderance (OR 1.1; 95% CI, 0.41–2.91). Maximum number of eyes 34 (64.15%) that developed cataract had BCVA of ≥6/12 and minimum of 2 (3.77%) eyes had BCVA of ≤6/36. LOCS-III revealed 38 (71.69%) eyes (71.69%) having peripheral cortical cataract and 15 (28.30%) posterior sub-capsular cataract.

Conclusions: There is a possible risk of association of cataract amongst user of antidepressants. The AD use of more than 1 year or longer had increased risk for development of cataract with a female preponderance. The highest risk was observed in the users of SSRI as compared to SNRI and TCA. Treatment exposure with antidepressant was longer for mild depression having more than two episodes.


Diagnostic and statistical manual of mental health-5, Hamilton rating scale for depression, Lens opacities classification system-III, Selective serotonin reuptake inhibitor, Selective nor-epinephrine reuptake inhibitor, Tricyclic antidepressant

Full Text:



Ernst P, Baltzan M, Deschenes J, Suissa S. Low-dose inhaled and nasal corticosteroid use and the risk of cataracts. Eur Respir J. 2006;27:1168-74.

Kanthan GL, Wang JJ, Rochtchina E, Mitchell P. Use of antihypertensive medications and topical beta-blockers and long- term incidence of cataract and cataract surgery. Br J Ophthalmol. 2009;93:1210-14.

Klein BE, Klein R, Lee KE, Danforth LG. Drug use and five-year incidence of age-related cataracts: the beaver dam eye study. Ophthalmol. 2001;108:1670-4.

Ludwig J, Marcotte DE, Norberg K. Anti-depressants and suicide. J Health Econ. 2009;28:659-76.

Boerrigter RM, Sietsema JV, Kema IP. Serotonin (5-HT) and the rat’s eye: some pilot studies. Doc Ophthalmol. 1992;82(1-2):141-50.

Weinstock M, Scott JD. Effect of various agents on drug induced opacities of the lens. Exp Eye Res.1967;6:368-75.

Van Walraven C, Mamdani MM, Wells PS, Williams JI. Inhibition of serotonin reuptake by antidepressants and upper gastrointestinal bleeding in elderly patients: retrospective cohort study. BMJ. 2001;323:655-8.

Ginzburg R, Rosero E. Risk of fractures with selective serotonin-reuptake inhibitors or tricyclic antidepressants. Ann Pharmacother 2009; 43: 98-103.

Etminan M, Mikelberg FS, Brophy JM. Selective serotonin reuptake inhibitors and the risk of cataracts. Ophthalmology. 2010;117:1251-5.

Costagliola C, Parmeggiani F, Sebastiani A. SSRIs and intraocular pressure modifications: evidence, therapeutic implications and possible mechanisms. CNS Drugs. 2004;18(8):475-84.

Candia OA, Lanzetta PA, Alvarez LJ, Gaines W. Inhibition of ionic transport and ATPase activities by serotonin analogues in the isolated toad lens. Biochem Biophys Acta. 1980;602:389-400.

Vivekanandan S, Lou MF. Evidence for the presence of phosphoinositide cycle and its involvement in cellular signal transduction in the rabbit lens. Curr Eye Res. 1989;8:101-12.

Chidlow G, Le Corre S, Osborne NN. Localization of 5-hydroxytryptamine-1A and 5-hydroxytryptamine-7 receptors in rabbit ocular and brain tissues. Neuroscience. 1998;87:675-89.

Hoyer D, Hannon JP, Martin GR. Molecular, pharmacological and functional diversity of 5-HT receptors. Pharmacol Biochem Behav. 2002;71:533-54.

Sharif NA, Senchyna M. Serotonin receptor subtype mRNA expression in human ocular tissues, determined by RT-PCR. Mol Vision. 2006;12:1040-7.

American Psychiatric Association. (DSM-5) Diagnostic and statistical manual of mental disorders (5th ed.) Arlington, VA: American Psychiatric Publishing. 2013:155-88.

Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967;6(4):278-96.

Chylack LT, Wolfe JK, Singer DM et al. Lens Opacities Classification System III. The Longitudinal Study of Cataract Study Group. Arch Ophthalmol. 1993;111:831-6.

Erie JC, et al. Selective serotonin reuptake inhibitor use and increased risk of cataract surgery: a population-based, case-control study. Am J Ophthalmology. 2014;158:192-7.