antidepressant, any advice?

[autumnn]

Hi all- Please forgive me if this is a re-post but I believe that I need some medication to help me....I can hardly get out of bed and have thoughts of worthlessness. Anyway, in the past I have taken Wellbutrin (long before the dry eye) and dont remember it drying anything but my mouth and I remember at first some blurry vision (temporary side effect)- still I am terrified to try something that could cause me to get worse...has anyone any advice on an antidepressant? Anyone want to share what they are taking and how it has affected their eyes? I know everyone is different but it would help to hear.

Also, do medications affect MGD or just aqueous dry eye?

Thank you in advance.

[Eli]

I think that medications can potentially be very helpful to you if you are nearly immobilized with symptoms of depression. You are however, correct in that many of them can in fact cause/exacerbate symptoms of dryness. I think the drugs interact with the neural pathways that help control normal tear production. In general, I do not believe they have any direct effect on meibomian glands. Also, my psychiatrist told me that any medication that has "dry mouth" listed as a possible side effect also has the potential to cause dry eye as well. Even if it isn't wasn't reported in the clinical trials. This is not to say that everyone taking the medication will suffer from either side effect. I take Lexapro, an SSRI, myself. Unfortunately, it does make my eyes somewhat drier. The beneficial effects of the drug though seem to outweigh the cons for me. For you, I would highly recommend some psychological counseling if you haven't done so already. Also, maybe consider trying an anti-depressant. Remember, there is no guarantee that it will make your eyes worse and you don't have to take it forever. For some people, medication can really help get them out of a rut. Two last bits of advice; avoid the older "tricyclic" anti-depressants if possible, as their drying effects are known to be much more pronounced. Also, if you are prescribed a medication, DO NOT STOP TAKING IT SUDDENLY unless your doctor says its okay (for instance Wellbutrin might be fine) as some people can have bad withdrawal symptoms if the dose isn't titrated slowly. Good luck!

[autumnn]

Eli- Thank you so very much for your response, I will make an apt with a psych and avoid the tricyclics.... From what I am told I dont have a problem with tear volume- just quality- low meiombian oil/low TBUT. I was recently plugged too and seem to have even more aqueous volume and wonder if I am OK with a med that may be a little drying for this reason. I am so scared to change anything as I have been told I am making some progress.

[Teri]

I'm glad to hear you have an appointment with a psychiatrist. He or she should be able to work around your dry eye problems.

I, too, have really struggled with depression, and I have not yet found an anti-depressant that works for me. I have tried Wellbutrin, Remeron, Seroquel, and Celexa so far. None of them noticeably dried my eyes out, all had really unpleasant side effects, and none of them improved my mood.

My doctor started with the "atypical" antidepressants since nearly all of the "traditional" SSRI's are known to cause dry eyes. I decided I had to try SSRI's, and Celexa was the first one I tried. He is trying to stay away from the ones that have a long half-life, meaning they will stay in your body for a long time. Prozac is the best example of this; its half-life is on the order of weeks, so if it makes your eyes worse, it'll stick around in your system for quite some time, making you miserable.

The way it was explained to me: some people go in, get a script for Zoloft, and go on their merry way, their mood lifted, etc. Others (me) have to search for a medication that helps their mood without intolerable side effects (dry eyes, for one).

I'm still searching for the right medication to help me, but I have also been seeing a psychologist. Therapy has been an enormous help to me, so if you aren't already, please consider seeing a therapist.

Good luck & hang in there.

[odydnas]

If an anti-depressant makes your eyes drier, is it permanent, or do you feel better after you stop and the anti-depressant is out of your system? I'm really scared to try anti-depressants...but my psychologist is really pushing me to see a psychiatrist..

[Rojzen]

too many preconceived notions can delay real help

Autumn, I implore you not to assume that you will have adverse effects from any particular antidepressant until you try it. If you read package inserts on side effects, you'll see that even when a drug causes some effect, like drying, this is NOT likely to last once the drug is stopped. . .If a doctor wants you to give something a try, it seems eminently wise to go ahead and do just that. . .

Also, it is extremely unhelpful, in my view, to rule out a whole class of antidepressants, like tricyclics, on the mere assumption that they will dry YOU.

Side effects are HUGELY individualistic, and only trial and error can tell you how you'll fare on a particular one. In addition, the tricyclics are well known to be able to reduce ocular surface sensitivity in some patients, and are increasingly being used in dry eye, DESPITE their reputation for drying. . .As Eli said, it's a balance. . .More importantly, YOU may not experience dryness from the antidepressants that are getting a bad rap here . . .

I need to add what is commonly forgotten here: DEPRESSION and ANXIETY can themselves exacerbate dry eye. . .If left untreated, it is possible that these serious conditions may not only prolong mental suffering, but also make one's eyes feel worse. . .

[Justpeachythx]

For what it's worth, I think we all react differently to different meds and the only way to know for sure is to give it a try. Personally, I have been taking amitriptyline (sp?) since mid-November and haven't experienced any drying of the eye. I am taking it primarily to help sleep through the night (it has sedation as a sideaffect) and the doctor suggested I start with the lowest possible dose and increase gradually until I find the point where I'm sleeping through the night, but waking without a "hang-over".

I've had no problems with ami and in fact think it may be contributing to my dryeye "remission". I've definitely been in a better emotional state.