Zoloft induced dilated pupils (A rare side effect)

In this blog, we are going to talk about zoloft induced dilated pupils. Zoloft, an antidepressant, is known to cause problems related to eyes or vision. In this blog, we will discuss how zoloft can produce such effects and what could be done to avoid it.

Zoloft induced dilated pupils

Zoloft induced dilated pupils, also known as ‘Mydriasis’, is reported by some of the users. The incidence of this side effect is not that high. Approximately 0.1 – 1% of people have reported it, usually within 2-3 weeks of treatment.

Researchers revealed that this side effect is indeed rare and it is not that disturbing, but if it is coupled with increased intraocular pressure, then it can result in complications like glaucoma, optic neuropathy etc. 

One theory suggests that zoloft can stimulate your sympathetic nervous system, which can result in pupil dilation. It can also cause the same effect by inhibiting the parasympathetic nervous system. 

Make sure you discuss with your healthcare provider if you experience zoloft induced mydriasis.

What could be done to avoid it?

There is nothing that you can do to avoid it. Zoloft induced side effects usually begin to fade away on their own, in around 3 to 4 weeks. You just need to give your body enough time to adapt to the medication.

Meanwhile, you can try protecting your eyes when you’re exposed to sunlight or allergens. Sunglasses are a good option to prevent any dust or fumes getting in your eyes. 

It is also not recommended to put extra burden on your eyes by using a smartphone or watching television excessively. Make sure you keep your eyes rested. You can also add a suitable lubricant in your eyes in case they get dry or itchy.  

It is not recommended to stop using zoloft cold turkey thinking that this way you could stop the occurrence of side effects. This is not the case. Instead, you will end up opening your doors for discontinuation syndrome. 

What other medications can cause mydriasis?

It is extremely important to monitor how many medications you are actually taking. People living with more than one prescription drug have to make sure their meds are compatible with one another. 

Some drugs are known to produce similar side effects. When such drugs are used concomitantly, they produce synergistic side effects which are much more pronounced than side effects produced by either of these medications alone. 

Other drugs which can cause dilation of pupils or mydriasis include the following:

• Anti-allergy medications
• Anticonvulsants
• Atropine
• Botulinum toxins
• Decongestants
• CNS stimulants
• Anti-anxiety medications like benzodiazepines.
• Controlled substances like cocaine, heroine, amphetamines, ecstasy etc

Make sure you are not using these meds along with zoloft. It is crucial to properly inform your doctor about your medications, including over-the-counter drugs. It is important to rule out any drug-drug interaction to protect you from further complications.

Health conditions which can make an impact on your mydriasis

Dilation of pupils is also found associated with some health conditions. These include:

Brain trauma

Brain injury or trauma can have an impact on your eyes. Mydriasis is common in people with damaged brains, as a result of some trauma of injury. Such conditions can put pressure on the eyes and can cause optic nerve damage.

Eye injury

Injury to an eye can also damage visual nerves and can cause dilated pupils and blurred vision.

Increased amounts of oxytocin

Several studies have suggested that an increased amount of oxytocin in your body can cause pupil dilation. 

Does zoloft cause any other ocular side effects?

Zoloft can affect your eyes in more ways than just blurring your vision. These include:

Blurry vision

Zoloft can cause blurry vision in people just after a week or two of using zoloft. It can cause nerve damage and increase intraocular pressure which can compromise your vision and can make things look blurry.

Optic Neuropathy 

Optic neuropathy is a condition which arises when your optic nerve is damaged. In a recent study, reviewed in the UK Journal, five cases with optic neuropathy are found to be connected with the long term use of SSRIs. 

In these case studies, people with 7-14 years of zoloft use had to discontinue the treatment because of optic neuropathy and visual changes. 

These changes could be reversible or irreversible, depending on the severity of damage that has been done. For some people, it took 6-18 months to fully recover from zoloft induced ocular side effects. 

Acute glaucoma 

The use of zoloft can increase intraocular pressure which gives rise to a condition known as acute glaucoma. It happens when the fluid in your eye builds up and does not drain how it normally should. 

This causes increased pressure on your eyes and you suffer from pain, redness and blurry vision.

Acute myopia

Zoloft can also cause acute myopia as it can have a direct impact on pupils. The pressure and nerve damage can make it difficult for you to see objects near you clearly. 

Dry eyes

Zoloft is also associated with drying your eyes out. It is a side effect reported by people with long-term zoloft use. It can cause pain, redness, itching and irritation in your eyes. 

Make sure you talk to your healthcare provider before using zoloft. If you have any eye problem, ask your doctor if it’s safe for you to use zoloft. Ocular side effects can also start to appear when you increase the dose or suddenly go from lower to higher doses. 

When to see your doctor:

Consult your doctor if:

• Your pupil dilation is coupled with pain, redness, blurred vision or burning sensation.
• Your eyes become watery
• You feel excessive pressure in your eyes
• You notice any swelling around your eyes
• Your eyes become extremely sensitive to light

Make sure you talk to your doctor and rule out any dangerous underlying condition. Do not stop zoloft abruptly. Your healthcare provider will suggest if you should continue using zoloft or stop it. 

Other rare and dangerous side effects of zoloft

Some of the side effects  of zoloft are serious and they require immediate medical attention. These include:

• Skin allergy, which could include Stevens-Johnson. You might notice red, swollen, or blistered skin, with or without fever. 
• Allergic reactions, like rash, hives are common. It also includes wheezing, difficulty in breathing, tightness in the chest, trouble breathing, swallowing, or swelling of the mouth, face, lips, tongue, or throat. Few of these symptoms indicate anaphylactic shock. 
• It could cause low sodium levels which can result in psychological symptoms like confusion, agitation, inability to understand surroundings, memory loss etc.
• It can cause elongation of QT interval, causing increased heartbeat or arrhythmia
• Convulsions 
• The inability to have an erection
• Hypothyroidism (low thyroid gland function)
• Bone marrow failure associated with low blood counts
• Thrombocytopenia
• Neutropenia 
• Abnormal behaviour/mania 
• Suicidal thoughts
• Feeling guilty all the time
• Extrapyramidal symptoms

Zoloft facts

• Zoloft tends to induce suicidal behavior in users younger than 24 years of age. If you have someone who shows suicidal behavior or you see hopelessness in them, make sure you keep an eye on them and get medical attention as soon as you can. 
• The liquid form of zoloft usually contains alcohol. Consult your healthcare provider if you have diabetes, alcoholism, or some liver disease. 
• Elderly people and children are more susceptible to side effects
• Using zoloft in the third trimester can cause rare side effects in babies like breathing difficulties, seizures etc. 
• It can also pass into the breastmilk. Consult your doctor if you are a nursing mother.

Conclusion

In this blog, we discussed zoloft induced pupil dilation. It is a condition commonly known as mydriasis. Studies showed that this side effect is pretty rare and is not commonly found in people using zoloft. The variation in side effects is quite common because people react differently to medications. 

If you experience pupil dilation, make sure you visit your ophthalmologist and rule out any other underlying condition which could possibly contribute to this side effect. 

If your zoloft is solely responsible for it, ask your doctor if you should continue to use it or if it would cause more eye damage. If your side effects require you to stop zoloft, your doctor will suggest a proper taper schedule in order to wean off zoloft safely.

FAQs: dilated pupils zoloft

Why do my pupils dilate on sertraline?

zoloft can stimulate your sympathetic nervous system, which can result in pupil dilation. It can also cause the same effect by inhibiting the parasympathetic nervous system. 

Does Zoloft affect your eyes?

Zoloft can affect your eyes. It could cause following eye-related side effects:

• Dilation of pupil or mydriasis
• Optic neuropathy, a condition which arises when your optic nerve is damaged. 
• The use of zoloft can increase intraocular pressure which gives rise to a condition known as acute glaucoma. It happens when the fluid in your eye builds up and does not drain how it normally should. 
• Zoloft can also cause acute myopia as it can have a direct impact on pupils. The pressure and nerve damage can make it difficult for you to see objects near you clearly. 

Can Zoloft cause dry eyes?

Zoloft is also associated with drying your eyes out. It is a side effect reported by people with long-term zoloft use. It can cause pain, redness, itching and irritation in your eyes.

When should I be concerned about dilated pupils?

You should be concerned about mydriasis when:

• Your pupil dilation is coupled with pain, redness, blurred vision or burning sensation.
• Your eyes become watery
• You feel excessive pressure in your eyes
• You notice any swelling around your eyes
• Your eyes become extremely sensitive to light

Is sertraline an antidepressant?

Zoloft is an antidepressant, which belongs to the family of Selective Serotonin Reuptake Inhibitors, abbreviated as SSRIs. Zoloft increases the availability of serotonin in your brain. 

Serotonin is a neurotransmitter (a chemical) released by our brain which is responsible for modulating mood, cognition, reward, learning, memory, and various other psychological processes. 

What drugs can cause your pupils to dilate?

Following medications can cause mydriasis:

• Anti-allergy medications
• Anticonvulsants
• Atropine
• Botulinum toxins
• Decongestants
• CNS stimulants
• Anti-anxiety medications like benzodiazepines.
• Controlled substances like cocaine, heroine, amphetamines, ecstasy etc

References

• Worlsd Psychiatric Association –  Sertraline induced mydriasis-a rare case report https://www.morressier.com/o/event/5ca1d27b57558b317a13f5a3/article/5d1a038257558b317a140c41
• ZOLOFT Side Effects by Likelihood and Severity – https://www.webmd.com/drugs/2/drug-35/zoloft-oral/details/list-sideeffects
• Drugs That Cause Dilated Pupils – https://pathwaysrecovery.com/blog/drugs-that-cause-dilated-pupils/#:~:text=Drugs%20that%20can%20dilate%20pupils,meth%2C%20ecstasy%2C%20and%20ketamine.
• Jonathan Lochhead, Consultant Ophthalmologist – Keep an eye on the SSRI: help avoid possible sight-threatening adverse events https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4723200/#!po=6.25000
• J Lochhead. Eye (Lond). (2015) – SSRI-associated optic neuropathy https://pubmed.ncbi.nlm.nih.gov/26139049/
• Ciro Costagliola et al. Curr Neuropharmacol. (2008) – Selective serotonin reuptake inhibitors: a review of its effects on intraocular pressure https://pubmed.ncbi.nlm.nih.gov/19587851/