Journal roundup: Dry eye, mental health and quality of life
Dry eye and depression
This study looks to have gone quite a bit further than many others in terms of individual patient assessments - both psychiatric and ophthalmic - twice during the study. I am very happy to see such strong documentation behind a conclusion of this type:
It is important to pay attention to psychiatric symptoms in patients with DED and an investigation into appropriate treatment strategies for patients with DED in combination with psychiatric symptoms is needed in the future.
That is a compelling take-home message for all eye doctors treating dry eye. I really want to see these professions put a final stop to all the scaremongering about the potentially drying side effects of anti-depressants. It is possible to inform, and to help patients navigate risk and benefits, without inappropriately discouraging them from seeking treatments they may need.
The other take-home of course… for research circles… is that we really do need BETTER comparative data on the effects of various anti-depressants to help us better understand the global impact: Are we, or are we not, better off with thus-and-such an anti depressants, if we have dry eye and depression?
More: The Relationship of Dry Eye Disease with Depression and Anxiety: A Naturalistic Observational Study. (Kitazawa et al, Translational Vision Science & Technology, December 2018
SSRIs and dry eye with depression
So, here we are, yet another study on anti depressants and dry eye.
In this study, SSRI treatment - note that we don’t know how much or how long (the 3-6 week reference appears to be in reference to the rats, not the humans) - showed more inflammation and they identified a specific pathway for that. And there are other studies, like this one, of course showing a relationship between dry eye clinical signs and anti-depressants.
The problem, of course, for us patients is that our needs are much more nuanced than this.
Remember everything we know about the mismatch between signs and symptoms of dry eye?
What if, for argument’s sake, an anti-depressant makes one or more of my “clinical signs” of dry eye worse, but my eyes don’t FEEL worse; and what if as a result, I feel better, more able to cope, more stable, stronger, and more able to take care of myself? What if I may even feel more able to navigate complex medical decisions, more able to comply with treatments that don’t have immediate benefit but may help me longer term, etc? That’s an example of the general basis for hope upon which a dry eye patient may embark on anti-depressant therapy specifically for depression that started with dry eye. (Other than flat-out desperation, which happens a lot too!) And this is why ophthalmology and optometry need a more nuanced understanding of our needs as well.
More: Selective Serotonin Reuptake Inhibitors Aggravate Depression-Associated Dry Eye Via Activating the NF-κB Pathway. Zhang et al, IOVS January 2019
Dry eye, social support and social trust
This fascinating Japanese cross-sectional study finds that:
Those with the highest levels of social support and social trust were least likely to have DED
For purposes of this study, dry eye disease was defined as “the presence of clinically diagnosed DED or severe symptoms”.
More: Lack of social support and social trust as potential risk factors for dry eye disease: JPHC-NEXT study. Vu et al, The Ocular Surface, January 2019.
Sleep, mood (depression, anxiety) and dry eye
I already blogged about this here but I wanted to include it again for future reference as it’s specifically relevant to anxiety and depression.
Association Between Sleep Quality, Mood Status, and Ocular Surface Characteristics in Patients With Dry Eye Disease. Wu et al, Cornea, March 2019.