Which antidepressant should be avoided in a patient with angle-closure glaucoma?

Amitriptyline is the appropriate choice to avoid in a patient with angle-closure glaucoma due to its anticholinergic properties. Anticholinergic medications can lead to dilation of the pupil (mydriasis), which can precipitate an acute angle-closure episode by blocking the drainage of aqueous humor through the trabecular meshwork in the eye. In patients with existing conditions like angle-closure glaucoma, this can exacerbate their symptoms and lead to increased intraocular pressure, potentially resulting in damage to the optic nerve and severe vision loss.

In contrast, the other antidepressants listed, such as bupropion, mirtazapine, and fluvoxamine, do not possess significant anticholinergic effects, making them less likely to exacerbate glaucoma conditions in comparison to amitriptyline. Therefore, when managing a patient with angle-closure glaucoma, it is crucial to carefully consider medications that have minimal risk of increasing intraocular pressure.