The case series reported by Dr Ritch et al1 in the January 1994 issue of the Archives clearly points out the risks of the use of such highly anticholinergic tertiary amine antidepressants as imipramine hydrochloride in patients known to have narrow angles. In each case, ophthalmological awareness of the narrow angles preceded rather than resulted from imipramine treatment. The authors conclude by recommending close monitoring by an ophthalmologist for patients with narrow angles "for whom treatment with tricyclic antidepressants is indicated."
We believe that this recommendation is incomplete. The development in the last decade of new classes of antidepressants that are virtually devoid of any anticholinergic effects provides an important therapeutic alternative for such high-risk patients. The selective serotonin reuptake inhibitors such as fluoxetine hydrochloride, fluvoxamine maleate, sertraline hydrochloride, and paroxetine hydrochloride are effective and welltolerated antidepressants that have become extremely popular. Even if a tricyclic antidepressant must be
Epstein NE, Goldbloom DS. Oral Imipramine and Acute Angle-Closure Glaucoma. Arch Ophthalmol. 1995;113(6):698. doi:10.1001/archopht.1995.01100060020008
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