In addition to treating clinical depression, among other mental health issues, such as social anxiety, antidepressants may also offer ocular benefits: lowering the risk of developing age-related macular degeneration (AMD) and its progression, according to a recent study in the American Journal of Ophthalmology.¹

Specifically, after propensity score matching (PSM) of 633,535 selective serotonin reuptake inhibitor (SSRI) users, 826,404 serotonin-norepinephrine reuptake inhibitor (SNRI) users, and 501,873 tricyclic antidepressant (TCA) users, antidepressant use was linked with a significantly decreased risk of nonexudative AMD (RR 0.606 for SSRIs; 0.141 for SNRIs; 0.234 for TCAs), exudative AMD (RR 0.733 for SSRIs; 0.161 for SNRIs; 0.267 for TCAs), and progression to exudative AMD (RR 0.701 for SSRIs; 0.665 for SNRIs; 0.676 for TCAs) vs a control group.

The antidepressant users were ages 40 and older and identified and grouped based on antidepressant type from a patient database between October 2004 and October 2023. Users taking more than one type of antidepressant were not included in the study. The PSM was used to adjust for 17 confounders, such as age, cardiovascular diseases, hypertension, sex, and smoking status.

The researchers say the potential mechanisms of antidepressants that resulted in a lower risk of the onset of age-related macular degeneration (AMD) and its progression include decreased inflammation and oxidative stress, and neuroprotection due to upregulation of brain-derived neurotrophic factors and proinflammatory cytokine suppression. Additionally, the researchers caution the study’s findings are exploratory and hypothesis-generating, requiring further prospective and mechanistic studies.

“This is an interesting observation,” Mohammad R Rafieetary, OD, FAAO, president of the Optometric Retina Society, told Optometric Management. “First, we have to look at the ‘chicken and the egg’ equation; does vision loss associated with AMD cause depression? It is intuitive to say ‘yes,’ and I personally see signs of that in many of my AMD patients. Then the question becomes, does depression play a role in causing or progressing AMD, and it is also natural to say ‘yes.’ Patients with clinical depression are less active, smoke and drink more, and don’t have good dietary habits. All of these increase the risk of AMD and AMD progression. Therefore, is there a benefit to use antidepressants to reduce above risks. The quick answer would be ‘yes’ based on the reasoning above and the study results, with the caveat that further prospective and mechanistic studies are needed." 

Dr. Rafieetary stresses, however, that the prescribing of these agents should be by qualified mental health professionals. “The eye-care provider should be in tune of the tell-tale signs of depression and not to hesitate to refer patients to the appropriate providers or agencies,” he says. OM

Reference

1. Mahmoudzadeh R, Zaichik M, Farhani K, Salabati M, Randolph J. Antidepressant use and incidence and progression of age-related macular degeneration in a national United States database. Am J Ophthalmol. Published online August 28, 2025. doi:10.1016/j.ajo.2025.08.052