Antidepressants and Glaucoma — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

ModerateOld Age PsychiatryAntidepressants and GlaucomaMRCPsych Paper B

A 72-year-old woman with major depressive disorder requires antidepressant treatment. Ophthalmological assessment has documented untreated narrow anterior chamber angles, and she has been advised to avoid medicines that could precipitate acute angle-closure glaucoma pending definitive management. Which antidepressant class should be avoided if possible?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Tricyclic antidepressants

Tricyclic antidepressants are the class that should be avoided if possible. Their clinically significant antimuscarinic effects can cause mydriasis, obstruct aqueous drainage through an anatomically narrow angle and precipitate acute angle-closure glaucoma. UK SmPCs specifically warn that amitriptyline may provoke acute glaucoma in patients with shallow anterior chambers or narrow angles, and the trimipramine SmPC advises avoidance where possible. Mirtazapine and trazodone also warrant caution, but their SmPCs describe their anticholinergic activity as very weak or minor, making them less compelling answers. SSRIs and SNRIs can rarely be associated with ocular adverse effects, so prescribing still requires individual assessment, but they do not have the same marked antimuscarinic class effect. The risk relates principally to narrow-angle anatomy rather than glaucoma as an undifferentiated diagnosis.

Reference: Electronic Medicines Compendium, Trimipramine 50 mg Capsules, Summary of Product Characteristics, section 4.4, current live SmPC (last updated 26 April 2022): https://www.medicines.org.uk/emc/product/13668/smpc