Prozac/Fluoxetine side effect worries I need info please respond

[owainm]

Hi Ive not posted in about a year I am currently still trying to recover from a major relapse I had last year. I was doing ok sort of managing to survive day to day but them a couple of new stresseful events have caused my health anxiety to rocket again to the point where Ive been googgling all the time and phoning my optometrist for advice. Basically in 2016 I had a really bad few months which was related to me having a morbid fear of something happening to my eyes due to my meds. I got over this and thought it was in the past but two weeks ago it resurfaced and has had me super stressed out every day since. I am posting this here in the hope that someone may have some info for me as there are some pretty knowledgable folk on here.

My current issue is I am terrifed of getting aacg (acute angle closure glaucoma) from taking Fluoxetine. I know this condition has occured in folk taking ssris but that is because they are predisposed i.e. have narrow eye drainage angles. It also appears to be something that occurs as a side effect upon the initiation of starting an ssri and not something that can occur after years of use. Anyway I cannot find any really deffinative info on this as a result of taking ssris so am hoping someone on here will have the knowledge. I was on paroxetine 30mg for 18 years and never had a case of aacg. I now take Fluoixetine 60mg since June last year and have not had aacg.

Basicallly what im trying to find out is does aacg only occur upon treatment initiation or within a realtively quick time after starting an ssri i.e days/weeks/months and only in predisposed people (narrow eye angles) or can it occur after many years being on an ssri. Ive been on an ssri for 22 years so if it was going to have happened would it have happend by now and becuause it has not does that mean it will not occur. My optometrist tells me my eyes are fine and that I have wide open eye angles.
I am also concerned about the possiblity of getting normal glaucoma from being on meds for so long. The info on line is contradictory some say ssris can cause glaucoma others say it can actually reduced the chances of glaucoma by 30%. Finally Im wprried about the possibility of developing cataracts due to ssri use again info is contradicatory some say they do cause it others say ther is no link.

Thanks for taking the time to read my post and hopefully someone in this community can give me some answers
Cheers Owain

[panic_down_under]

The link between SSRIs and glaucoma comes down to about 10 case reports in the medical literature. Case reports are the least reliable evidence. There seems to have been only one relatively small study, Chen H-Y (https://pubmed.ncbi.nlm.nih.gov/27135704/), 2016, which found SSRIs increased the risk for acute angle closure glaucoma 5.8 fold, which sounds alarming except that for very rare conditions they are still a rarity. Also the study was of ethnic Chinese who are more prone to these glaucomas than Europeans.

The same authors Chen, H-Y (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912305/), 2015, which found no significant differences in primary glaucoma between those on SSRIs long-term and the controls. Which suggests acute angle closure glaucoma is likely to be a temporary side-effect when first taking SSRIs. If you don't have aacg now you are unlikely to in the future, Owain.