Depression in Newly Diagnosed Patients
Chat Highlights
October 17, 2007

On Wednesday, October 17, 2007, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Depression in Newly Diagnosed Patients."

Moderator:   Tonight's topic is “Depression in Newly Diagnosed Patients.”  How common is that?

Dr. Rick Wilson:  As depression is such a subjective problem, it needs to be assessed with developed questionnaires that have been validated on several populations before being used in a study.  In a study by Roy Wilson et al., depression scores for patients with glaucoma did not differ significantly from scores of control patients.

In both questionnaires, having past or present mental illness was the only consistent predictor for depression.  Among glaucoma patients, the level of visual acuity, the severity of visual field loss, and the use of topical beta blockers were not predictors for depression.  (Several earlier studies had suggested that beta blockers could aggravate depression.)

In another study (American Journal of Ophthalmology, August 2007), patients enrolled in a randomized clinical trial were interviewed about their quality of life.  Researchers determined that the odds’ ratio of reporting mood indicators and symptoms of depression increased with the patients’ perceptions of worsening visual function, but not with actual worsening in visual acuity or visual field.

That study says people, especially introspective people --who were more likely to interpret their daily function as decreasing -- were more likely to become depressed, even if their actual visual function was not decreasing.

P:  Can frequent self-testing of vision be misleading?

Dr. Rick Wilson:  To almost anyone who concentrates on testing his or her own vision and is worried about progression, the tendency is to perceive that they don't see as well as they did last month.  Without objective proof, it is easy for them to believe they are losing vision.
Since most glaucoma is controlled with eye drops and laser surgery, most glaucoma patients are stable or only progressing slowly.  A saying in glaucoma is that we only need to maintain vision till mortality, not eternity.  That means a slow progression may be acceptable, if it does not result in the patient developing noticeable worsening of visual abilities during his or her lifetime.

P:  I thought depression was a common side effect of beta blockers. Is that wrong?

Dr. Rick Wilson:  One study of thousands of glaucoma patients in New Jersey found that the use of antidepressants was not any higher in those patients taking beta blockers than it was in those not taking beta blockers.  The inference was that beta blockers did not lead to depression.

P:  I had functional depression for almost a year after diagnosis of glaucoma.  I stopped using Lumigan.  After two weeks, my energy returned.  At three weeks, I felt completely like my pre-diagnosis self.  At four weeks, my appetite returned.  Could Lumigan have caused my depression?

Dr. Rick Wilson:  Systemic side effects from prostaglandins like Lumigan are infrequent but well known.  The most common are muscle aches and pains, with a mild flu-like feeling.  I have not heard of prostaglandins leading to depression, but I cannot say that is impossible.

P:  Do you find that most people think that a diagnosis of depression is a stigma?

Dr. Rick Wilson:  Because depression is a malady of the mind and its chemical balance, and not the body, most people feel it is a stigma -- that depression is too close to having something wrong with your mind.

Depression can be genetic, with a chemical imbalance in the neuro-active chemical agents affecting the brain, but it can also be caused by a life situation, such as the diagnosis of glaucoma, a sight-threatening disease.

P:  It seems that patient education is one tool to overcome depression in newly diagnosed glaucoma patients.  I think it also helps to have a place to get reliable information and talk to others.

Dr. Rick Wilson:  That's absolutely correct.  I think it is crucial for the diagnosing doctor to explain that most of the vision lost to glaucoma occurs before the patient sees the doctor and is diagnosed.  Once the patient is being treated, further progression usually can be limited.

Moderator:  Thanks, Dr. Wilson.

Dr. Rick Wilson:  I hope everyone has an enjoyable two weeks.  Good night and good luck.

On November 7, Dr. Spaeth discussed "Glaucoma Disability and Assessment" in the Chat room. Click here for highlights of that meeting.

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