Heidu - Aw c'mon, we have socialized medicine here in Canada, too, and it's not really that bad when you look at countries without comprehensive medical care. We complain about our system, too, but every time I am in the U.S. I hear about HMO horror stories I am grateful for our systems.

Yes, blurred vision can occur with Paxil™ (paroxetine), and other SSRI-like antidepressants There are a number of potential reasons for a change in visions when using these drugs and the vision change could be due to one or several underlying "side effects".

Paxil, with it's blockade of muscarinic (cholinergic) receptors can cause a bodywide drying of membranes. This includes: a dry mouth and an associated increase in thirst (and possibly also contributing to an increased incidence/likelihood of halitosis); a decrease in vaginal lubrication; drying of nasal secretions; thickening of earwax; constipation; urinary retention; and, of interest to us, a decrease in tear production.

The decrease in tears leads to dryer eyes, which can cause the blurry vision that you are mentioning. The body does respond to the drying and does try to reverse the trend. Blurring due to dryness can be looked at as a "start-up" side effect that fades to some extent, but there can be residual dryness for number of months before the body totally compensates for the muscarinic blockade initiated by the Paxil.

Paxil has a better track record of treating panic disorder, and other anxiety disorders, than the other SSRIs due to Paxil's blockade of muscarinic receptors. As an aside, it is muscarinic blockade that causes the excessive dry mouth, constipation, and much of the drowsiness associated with the older tricyclic antidepressants (TCAs) like amitryptyline (Elavil™) and nortriptyline (Aventyl™). Paxil does not bind to muscarinic receptors as tightly or as readily as the TCAs, so it does not cause the above side effects to the same extent as the TCAs, hence the Paxil is a better tolerated antidepressant.

The anticholinergic-induced drowsiness induced by Paxil is less than that induced by the TCAs and seems to resolve much sooner than with the older drug. The drowisness caused by Paxil usually resolves more quickly than does the vision changes, giving us an indication that there are other factors involved in Paxil-induced vision changes.

Another way that vision can be modified by Paxil is through abnormalities of "<A target="_blank" HREF=http://www.bartleby.com/61/22/A0042200.html>accommodation</A>". Accommodation, as it pertains to the eye is, "(t)he automatic adjustment in the focal length of the lens of the eye to permit retinal focus of images of objects at varying distances". Slower accommodation by the eyes can lead to blurry vision.

Paxil has also be known to cause "<A target="_blank" HREF=http://www.bartleby.com/61/77/M0507700.html>mydriasis</A>" which is a "(p)rolonged abnormal dilatation of the pupil of the eye caused by disease or a drug". When the pupil is slow to react to light (ie. slow to contract), blurred vision and sensitivity to light can result. The eye usually adapts to this side effect as well.

Another possible explanation for vision changes as a side effect of Paxil is through complications from the development of "<A target="_blank" HREF=http://www.bartleby.com/61/34/C0573400.html>conjunctivitis</A>" instigated by the drug, which is defined as, "(i)nflammation of the conjunctiva, characterized by redness and often accompanied by a discharge". The "<A target="_blank" HREF=http://www.bartleby.com/61/32/C0573200.html>conjunctiva</A>" is, "(t)he mucous membrane that lines the inner surface of the eyelid and the exposed surface of the eyeball". When conjunctivitis occurs because of Paxil the reason can usually be traced to the anticholinergic-induced decrease in tear production, and thus decreased moisture in the eye, leading to red (irritated) eyes, and potentially to an opportunistic bacterial infection of the eye(s).

This bacterial infection may result from a decrease in the ability of the body's immune system to clear bacteria from the eye as readily. A decrease in tear production means that bacteria is not as readily washed away as they normally would; also since there are less tears, there are fewer immune cells on the eye to kill the bacteria.

All this being said, the incidence of vision changes caused by Paxil is beween 3% and 4%. The initial amount of vision change will vary from person to person, as will the degree to which the eyes will ultimately compensate for the drug-induced vision changes. I always advise that one waits at least 6 months after starting Paxil before having there eyeglasse/contact lens prescription changed. This is to give the eyes time to find a new steady state level.

The level to which one's eyes will ultimately change (if indeed they do) is very patient variable, so one cannot predict this ahead of time. Changing one's prescription before (approximately) six months may be a waste of money, as the vision changes may not have settled out and one will have to have their lenses ground again.

As for one's vision changing upon discontinuing Paxil, I would expect that this is possible. This is probably more likely to occur in someone whose vision changed when they started the Paxil. I have heard of people's vision changing enough to require a prescription change after starting Paxil, but I have never heard of someone's vision changing after stopping Paxil; but then again, I have never inquired about this (I usually don't see people after they've stopped taking medication like Paxil).

I hope that this long-winded answer is of help. - Cam

P.S. The vision changes are not dangerous, but are not usually severe.