title: Toxic optic neuropathy after concomitant use of melatonin, zoloft, and a high-protein diet.
abstract: Melatonin is a neuromodulating hormone found in the pineal gland and retina. It is involved in light-dark circadian rhythms and mediates retinal processes in a manner antagonistic to that of dopamine. Zoloft (sertraline) is an antidepressant drug that blocks the reuptake of serotonin at the neural synapse. Serotonin is the natural precursor of melatonin. A 42-year-old woman sought treatment for visual acuity loss, dyschromatopsia, and altered light adaptation. Neuro-ophthalmologic examination was otherwise normal except for evolving bilateral cecocentral scotomas. She had taken Zoloft for 4 years and began a high-protein diet with melatonin supplementation 2 weeks before onset of visual symptoms. Visual acuity and color vision improved within 2 months after melatonin and the high-protein diet were discontinued. Combined use of melatonin, Zoloft, and a high-protein diet may have resulted in melatonin/dopamine imbalance in the retina, manifesting as a toxic optic neuropathy. Physicians and patients should be alerted to this potential drug interaction.
authors.affiliation: Neuro-ophthalmology Unit, Mason Eye Institute, University of Missouri-Columbia, USA.
authors.forename: N L
authors.initials: NL
authors.lastname: Lehman
authors.forename: L N
authors.initials: LN
authors.lastname: Johnson
mesh_terms: D000221:Adaptation, Ocular / Q000187:drug effects; D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects*; D003117:Color Vision Defects / Q000209:etiology; D004044:Dietary Proteins / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008550:Melatonin / Q000009:adverse effects*; D009900:Optic Nerve / Q000473:pathology; D009901:Optic Nerve Diseases / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D012607:Scotoma / Q000209:etiology; D020280:Sertraline / Q000009:adverse effects*; D014792:Visual Acuity / Q000187:drug effects
chemical_list: D000928:Antidepressive Agents; D004044:Dietary Proteins; D008550:Melatonin; D020280:Sertraline