From the Guidelines
Sertraline can be prescribed for anxiety in a 13-year-old with glaucoma, but with caution and close monitoring by both a psychiatrist and an ophthalmologist. While sertraline (Zoloft) is FDA-approved for treating obsessive-compulsive disorder in children and can be prescribed off-label for anxiety in adolescents, the glaucoma complication requires special consideration. Sertraline has anticholinergic properties that could potentially worsen certain types of glaucoma by increasing intraocular pressure 1. Before starting this medication, the child should have a thorough evaluation by both a psychiatrist experienced in pediatric cases and an ophthalmologist to assess the specific type of glaucoma and potential risks. The treatment would typically start at a low dose (12.5-25mg daily) with gradual increases if needed, while closely monitoring for any changes in eye pressure or vision.
Some key considerations when prescribing sertraline to children and adolescents with anxiety disorders include:
- Starting with a low dose and gradually increasing as needed and tolerated 1
- Monitoring for potential adverse effects, such as suicidal thinking and behavior, behavioral activation/agitation, and serotonin syndrome 1
- Considering alternative anxiety treatments, such as cognitive behavioral therapy, as first-line or complementary approaches 1
- Regular follow-ups with both specialists to monitor both anxiety symptoms and eye health throughout treatment 1
It is essential to weigh the potential benefits of sertraline against the potential risks, particularly in the context of glaucoma. Close collaboration between the psychiatrist, ophthalmologist, and patient/family is crucial to ensure safe and effective treatment.
From the Research
Sertraline Prescription for Anxiety in a 13-Year-Old with Glaucoma
- The study 2 suggests that sertraline can be safely administered to pediatric patients, including 13-year-olds, for the treatment of anxiety and depression.
- However, it is essential to consider the potential interaction between sertraline and glaucoma, as some studies 3, 4 indicate that SSRIs, including sertraline, may affect intraocular pressure (IOP) and increase the risk of glaucoma.
- The study 4 found that the use of SSRIs was not associated with a higher risk of glaucoma, but it did suggest that antidepressant treatment may be associated with lower IOP and higher pupillary diameter.
- Another study 5 highlights the importance of stress reduction in glaucoma patients, as stress can increase IOP and worsen glaucoma symptoms.
- When prescribing sertraline to a 13-year-old with glaucoma, it is crucial to monitor IOP and adjust the treatment plan accordingly, as suggested by the study 3.
- The study 6 also emphasizes the importance of considering the patient's CYP2C19 genotype when prescribing sertraline, as it may affect the drug's metabolism and dosing requirements.