Depression and dry eye

This is just totally off the cuff... I was responding to an email tonight asking about antidepressant medication and dry eye, and I thought I would re-post here what I put in the email, since it's a common concern.


I am afraid to treat depression with medication for fear it will make my eyes worse. I was curious if the research shows depression causing dry eye or vice versa. If depression causes it or contributes to it, that would be interesting to know. 


It's a really challenging subject and there's just no way to generalize it because everyone's needs, as well as responses to medication, vary. But from where I stand, for what it's worth:
  • A majority of people I know who have been through severe phases of dry eye have suffered from depression at times AND most of those have used antidepressant medication at one time or another.
  • Just because an antidepressant CAN make dryness worse, that does not mean it WILL (it's simply an increased risk), and even if it does slightly increase dryness, that doesn't mean it will increase SYMPTOMS from dryness, and even if it increases those somewhat, it may still be a reasonable tradeoff for getting depression under control. There are a lot of medications that have anticholinergic effects and not everyone can avoid all those meds all the time. Increasing dry eye treatment or comfort remedies (like moisture goggles etc) can help balance things out. On the other hand, if you know effective non-medication tools for dealing with depression, so much the better. But I don't believe in saying no to meds based on the dry eye risk alone. Our overall well-being as humans is more important than our eyes alone and everyone has to make their own personal call about what those needs are at a given time.
  • In the Facebook groups, people are constantly saying how thus-and-such an anti-depressant made their dry eye worse but thus-and-such another one didn't. It's a reality. Experimenting is not a lot of fun, but in the right situation, it's worth it.
  • Based on medical studies to date (published and not yet published) the relationship between depression and dry eye is VERY complex. There's a ton of research being done and it'll be a long time, in my opinion, before it's more thoroughly understood. I think there's no question that dry eye can lead to depression (all kinds of reasons) but it also seems to be the case that depression may make you more vulnerable to dry eye or may even make your tear film respond differently to triggers. It's all very interesting :)
These are hard chicken-or-the-egg calls. Personally though I tend to lean towards "treat the depression", or the anxiety which is probably even more common - it's my personal bias because in all of the phone sessions I have had with patients over the years who are trying to figure out where to go next with dry eye, I have so often found it to be the case that that depression and anxiety cripple their ability to access good care and to make good choices about their eye care. It's just too much sometimes.

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