Can Antidepressants Cause Visual Snow Syndrome?

New article

We are pleased to announce the publication of a new peer-reviewed article based on data from RxISK: “Serotonin reuptake inhibiting antidepressants: A trigger for visual snow syndrome?”

It can be freely viewed and downloaded. We would be grateful if you could share it as widely as possible.

To our knowledge, it is the biggest series of visual snow cases linked to a particular drug group. But of further interest is the evidence that visual snow and visual snow syndrome can endure for months or years after serotonin reuptake inhibiting antidepressants are stopped.

We have previously mentioned a link between visual snow and antidepressants in several blog posts, going all the way back to Keeping an Eye on the Ball in December 2013.

Then, in 2022, we published a peer-reviewed article about a range of different visual problems linked to serotonin reuptake inhibiting antidepressants. This included several reports of visual snow.

Almost as soon as that article was published, there were discussions about the possibility of writing one specifically for visual snow. Despite a significant number of publications about this condition in the academic literature, very little has been written about a link with antidepressants, so there seemed to be a gap in the knowledge base that our data could help to fill.

Not all cases of visual snow are linked to antidepressants, but the data suggests that the use of certain types of antidepressants may be responsible for the condition in some people.

Through a long and fruitful collaboration with Jonathan Lochhead and Hannaa Bobat over some years now, we and they have come to realise that most ophthalmologists examining the eyes of people with visual snow syndrome, and failing to see visible damage, assume the effect is in the brain or the mind – an assumption that may be reinforced if the person is on or has been on an SSRI.

There is, however, comparatively more serotonin in our eyes relative to their size than in our brain, and those of us linked to the new article are beginning to consider the idea that we may well be dealing with something in the eyes. The implication of this, as with PSSD, is that it does people complaining about real difficulties a disservice to suggest they have a mental problem.

Road to publication

The article has had an interesting road to publication.

An earlier version of the manuscript was submitted to a journal in mid-2024 who replied saying “your manuscript did not receive a high enough priority score to be sent out for external review”. It was rejected without review.

We then sent the manuscript to another journal on 9 December 2024. Based on previous experience with that journal, we suspected they might also reject it. They did – without review.

We then submitted it to BMC Ophthalmology on 19 December 2024. This seemed like a better fit for the article, and we hoped that inclusion in this journal would increase awareness of Visual Snow linked to antidepressants among the ophthalmology community.

On 23 December 2024, we received a response from the journal asking for a small change to our ethics statement. We made the adjustment and resubmitted it a few days later. Then we heard nothing.

We still hadn’t heard anything by the middle of March 2025. This was very unusual, and we wondered if we had missed an email or had done something wrong during the submission process. We contacted them to see what was happening.

On 18 March 2025, we received an email from Dr Sushila Kamble, assistant editor at BMC, apologising for the delay. She explained:

“We have unfortunately been having problems obtaining sufficient reviewer reports as requested by the handling Editor and as such, your manuscript is still going through the peer review process.”

This seemed a little unusual. If our article had been about an unknown condition that was on the edge of the journal’s scope, it might make sense that they were having difficulty finding reviewers. But this was an ophthalmology journal, and the article was about a well-documented visual problem. We also noticed that the journal was publishing a high number of new articles every week and didn’t seem to be having difficulty finding reviewers for those.

We thanked Dr Kamble for the note and, as an aside, we informed her that the World Health Organization (WHO) had announced that visual snow syndrome now features in ICD 11, the most recent edition of the International Classification of Diseases.

Things went quiet again.

A colleague

By the end of April 2025, we hadn’t heard anything further. But coincidentally, one of us heard from a colleague who recently had a strange experience with another BMC journal.

He had submitted a meta-analysis involving adverse effects of a medication – nothing to do with visual problems or antidepressants. A meta-analysis is a type of study that brings together the results of existing studies into one larger study, thereby helping to build a bigger picture.

After several months of reviews and revisions, and with three peer reviewers seemingly happy with the article but one with quibbles, it was rejected by the journal. The person appealed and was apparently told:

“There is no advance presenting or analysing the updated/existing evidence in a valid manner such as meta-analysis.”

It went on to say that the drug regulator should be left to decide whether or not there is a problem.

Meta-analyses are a common type of research in the academic literature, so this is a new reason for an article to be rejected. It made us wonder whether this was indicative of BMC’s position on adverse drug effects and might explain their reluctance to accept our paper.

Another note to BMC

On 1 May 2025, we emailed Dr Kamble at BMC Ophthalmology to ask for an update. We explained the importance of the research, offered to provide the details of a possible reviewer if they were still having difficulty finding someone, and also asked whether the fact that our article involved adverse drug effects was causing difficulty. There was no response.

In the academic world, having articles rejected isn’t unusual, but it’s unusual for a journal to put an article out for peer review and then simply stop communicating with the authors. Even when reviewers don’t like an article, they are often still happy to review it, even just to reject it.

Our article wasn’t introducing a new concept. There were already two publications linking serotonin reuptake inhibiting antidepressants to the onset of visual snow.

Was there internal disagreement about whether or not it should be accepted? Did the journal not want to accept the article, but also not want to be seen rejecting it?

Checking the online status showed that it was still apparently in the peer review process.

Switch to IJRSM

By the middle of June 2025, there had been no response. We decided it wasn’t worth pursuing BMC Ophthalmology any further, so we submitted the manuscript to the International Journal of Risk and Safety in Medicine.

After a few weeks, we heard back. The article had been peer reviewed and was being considered for publication pending some minor revisions. We were a little surprised to find that the reviewers had raised 66 different points.

Keeping track of all the comments, making the changes, and typing up the responses to the reviewers was quite a task. But we responded to the points, made 32 minor changes to the manuscript, and resubmitted it.

On 8 August 2025, we were informed that the article would now be accepted for publication pending some further small revisions. We addressed the reviewers comments and attempted to submit our second revision on 12 August 2025. Unfortunately, the journal had changed to a new system and it wasn’t letting us upload the documents. Journals are increasingly relying on automated systems rather than interacting with people.

After numerous emails back and forth over the next few weeks, the journal eventually agreed to accept the documents by email, and they would upload them at their end.

It was now the beginning of September 2025, and we assumed that everything was now resolved. We hoped to hear from the publisher shortly with a draft article for proof reading. But we heard nothing.

After chasing the journal a couple of times, it was discovered that the article had fallen through the cracks and nothing was happening with it. We were told that the peer reviewers hadn’t actually signed it off, so it would have to be sent to them for further review.

On 22 October 2025, we were informed that the article was now accepted (again).

A week later, the publisher had prepared our article for publication and provided us with a link to their online proofing system for checking. We got part of the way through and their system stopped working. Despite continued attempts, we couldn’t access it. We informed the publisher and waited for them to fix it. In the meantime, we received an automated email chasing us to complete the proof reading.

The system was eventually fixed, and the article was published online on 7 November 2025.

Another colleague

While trying to get the visual snow article published, another colleague was having an interesting experience with his own ophthalmology articles.

A few months ago, he completed a study suggesting that SSRIs may reduce the risk of a particular eye condition. The manuscript was accepted and published in a popular and highly regarded ophthalmology journal without any difficulty.

He has just completed another study of similar size and quality, but for a different eye issue. This study found an association between SSRIs and negative structural changes to the eye. So far, he can’t get it published. Journals are rejecting it as being unsuitable without even sending it out for peer review.

Journals often receive significant advertising revenue from pharmaceutical companies, so perhaps anything that mentions adverse effects is seen as bad for business.

Whatever the reason, the reality is that it’s becoming increasingly difficult to get any article published about serious adverse drug effects. The increasing use of automated systems is also not helping.