Exploring Side Effects of Donepezil and Lexapro in Dementia Patients

Drug side effects

Dear Doctor: My mother started taking Donepezil 5mg for dementia a few months ago and began taking Lexapro a month ago.
However, she has experienced blurred vision, making it difficult for her to read.
She has glaucoma, but her ophthalmologist found no significant degeneration in her eyes.
Could this be caused by the antidepressant medication, and will it improve? We would like the doctor to switch her to Zoloft, but the doctor believes that it has greater side effects.
Thank you.

Ms. Zhao, 50~59 year old female. Ask Date: 2018/10/28

Dr. Wu Enliang reply Psychiatry

Hello Ms.
Zhao,
For elderly patients, it is generally recommended to start antidepressants at a low dose to minimize the risk of side effects, such as the blurred vision issue your mother is experiencing.
If such side effects occur, it is advisable to reduce the dosage, as they often improve on their own after some time.

Regarding Zoloft and Lexapro, they are similar medications; however, Lexapro tends to have fewer interactions with other medications and may show effects slightly faster.
On the other hand, it may pose a higher risk of cardiac conduction issues.
Each medication has its own advantages and disadvantages.

Wishing your mother a speedy recovery.

Dr.
Wu Enliang

Reply Date: 2018/10/28

More Info

When considering the side effects of Donepezil and Lexapro in dementia patients, it is essential to understand the pharmacological profiles of these medications and how they interact with the patient's existing health conditions, such as glaucoma.

Donepezil is an acetylcholinesterase inhibitor commonly prescribed for Alzheimer's disease and other types of dementia. It works by increasing the levels of acetylcholine, a neurotransmitter associated with memory and learning. While Donepezil can improve cognitive function in some patients, it may also lead to side effects such as gastrointestinal issues, insomnia, muscle cramps, and, in some cases, visual disturbances. However, visual disturbances are not commonly reported as a direct side effect of Donepezil.

On the other hand, Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) used primarily to treat depression and anxiety disorders. Common side effects of Lexapro include nausea, fatigue, insomnia, and sexual dysfunction. Visual disturbances, including blurred vision, can occur with SSRIs, although they are not the most common side effect. In patients with pre-existing conditions like glaucoma, any medication that affects the central nervous system can potentially exacerbate symptoms or lead to complications.

In your mother's case, the onset of blurred vision after starting Lexapro raises a valid concern. Given her history of glaucoma, it is crucial to monitor her symptoms closely. While the eye examination showed no significant deterioration, the blurred vision could indeed be related to the introduction of Lexapro. It is advisable to consult with her prescribing physician to evaluate the possibility of adjusting the dosage or switching medications. Reducing the dose of Lexapro may alleviate the visual symptoms, as many side effects tend to diminish over time as the body adjusts to the medication.

Regarding the consideration of switching to Zoloft (sertraline), it is important to note that while both Lexapro and Zoloft belong to the same class of antidepressants, they have different side effect profiles. Zoloft may have a higher incidence of certain side effects, including gastrointestinal issues and potential interactions with other medications. Therefore, the decision to switch should be made cautiously and in consultation with her healthcare provider.

In summary, the blurred vision your mother is experiencing could be attributed to the initiation of Lexapro, particularly given her underlying glaucoma. It is essential to communicate these concerns with her healthcare provider, who can assess her overall treatment plan and make necessary adjustments. Monitoring her symptoms closely and maintaining open communication with her medical team will be crucial in managing her dementia and any associated side effects from her medications.

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