Depression and Anxiety Following Topical Carbonic Anhydrase Inhibitors

AbstractPurpose To investigate the association between topical carbonic anhydrase inhibitor (CAI) use and the development of depression and anxiety disorders in patients with glaucoma. Design Retrospective, multicenter cohort study. Subjects, Participants, and/or Controls Glaucoma patients aged ≥40 years were identified using ICD-10 codes H40–H42 and categorized into two groups: those prescribed topical CAIs (study group) and those with no history of CAI use (control group). Patients receiving systemic CAIs were excluded from both groups. Methods We analyzed de-identified patient data from the TriNetX United States Collaborative network. We performed propensity score matching (PSM) to balance demographic, ocular, and systemic covariates. Cox proportional hazards models were used to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Main Outcome Measures The primary outcome was new-onset depression (ICD-10 F32, F33, F43.21) and initiation of antidepressant therapy within 3 months, 6 months, and 1 year of topical CAI initiation. Secondary outcomes included new-onset anxiety disorders (F41). Results After PSM, the incidence of depression was higher among topical CAI users than controls at 3 months (1.42% vs. 0.77%), 6 months (2.46% vs. 1.41%), and 1 year (4.05% vs. 2.47%; all pConclusions Topical CAI use was associated with an elevated hazard of developing depression, initiating antidepressant therapy, and experiencing anxiety disorders within the first year of treatment. These findings highlight the importance of monitoring neuropsychiatric adverse effects in glaucoma patients receiving topical CAIs.