Quetiapine associated Central Serous Chorioretinopathy: Implicit role of serotonin and dopamine pathways

Abstract

A 30-year-old insomniac, an off-label user of quetiapine, presented with blurring of central vision, eventually diagnosed as central serous chorioretinopathy. A potential association was suspected based on the drug's actions on the autonomic nervous system. He showed improvement on drug withdrawal; then he unwittingly resumed quetiapine and had a recurrence. Possible underlying mechanisms that include alteration in choroidal perfusion through serotonin and dopamine receptors are discussed. Although retinal vein occlusions and pigment epithelial detachment have been described with quetiapine, to the author's knowledge, this is the first case report of quetiapine-associated central serous chorioretinopathy.

Sharing the Same Perspective. Mental Disorders and Central Serous Chorioretinopathy: A Systematic Review of Evidence from 2010 to 2020

“…However, this association could be due to the presence of a mental disorder itself, rather than the psychopharmacological treatment, which has even been proposed as a protective factor for vision outcome in CSC patients at onset [22]. Still, the Quetiapine assumption was correlated to exacerbation of CSC in a case-report study [20].…”

“…After the withdrawal of medication, he showed a marked reduction in both signs and symptoms of CSC. He showed recurrence of the disease when resumed quetiapine 10 months later [20].…”

Adverse ocular effects of neuroleptic therapy: semiotics, pathogenesis and treatment

“…Синдром сухого глаза Dry eye syndrome [47] Отмена препарата, искусственные слезы, циклоспорин местно, пилокарпин местно или внутрь Drug withdrawal, artificial tears, topical cyclosporine, topical or oral pilocarpine [6,48] Рисперидон Risperidone Кистозный макулярный отек Cystoid macular edema [39,40] Отмена препарата Drug withdrawal [39,40] Кветиапин Quetiapine Центральная серозная хориоретинопатия Central serous chorioretinopathy [41] Отмена препарата Drug withdrawal [41] Арипипразол Aripiprazole Экссудативная отслойка сетчатки Exudative retinal detachment [35] Отмена препарата Drug withdrawal [35] Транзиторная миопия Transient myopia [49][50][51][52][53] Отмена препарата Drug withdrawal [49][50][51][52][53] Таблица. Офтальмологические побочные эффекты нейролептиков и методы их лечения Table . Ocular adverse effects of antipsychotics and their treatment…”

“…Другие поражения сетчатки. В литературе описаны лишь единичные случаи следующих побочных эффектов: кистозный макулярный отек при приеме рисперидона [39,40], центральная серозная хориоретинопатия при использовании кветиапина [41], экссудативная отслойка сетчатки при употреблении арипипразола [35]. Во всех этих случаях снижение дозы препарата или его отмена приводили к регрессу патологических изменений без назначения дополнительной терапии [35,[39][40][41].…”

Synthesis, evaluation of drug delivery potential, and the quantum chemical investigation on a molecular imprinted polymer for quetiapine antipsychotic; a joint experimental and density functional theory study

“…This compound operates to restore the balance of some special chemical neurotransmitters or messengers in the central nervous system (CNS), which improves mood, behavior, and thinking (Garakani et al, 2020). It also works on blocking the receptors of serotonin and dopamine, two important neurotransmitters (Jain, 2019). Due to the wide usage of this compound, some formulations such as standard and slow-release tablets or oral suspensions were prepared commercially (Papazisis and Siafis, 2019).…”