Serotonin Reuptake Inhibitor Antidepressants and Abnormal Bleeding

Abstract

On the basis of the findings of our literature search, we suggest that SSRI-induced increase in gastric acid secretion may explain the GI bleeding risk and that SSRI-related effects on platelet reactivity, endothelial reactivity, and inflammatory markers may explain the ischemic heart disease protective effect. Because the absolute risk of GI bleeds with SSRIs is low, precautions are probably necessary only in high-risk patients, such as those with acid-peptic disease and those with a history of bleeds. We discuss management issues and areas for future research.

Antidepressant Augmentation With Anti-Inflammatory Agents

“…25,26 Next, depression is associated with an increased risk of ischemic heart disease events, 27 and NSAIDs may further increase this risk. For example, a meta-analysis of 25 studies showed that most of the commonly used NSAIDs were associated with a dosedependent increase in the risk of myocardial infarction 28 ; some NSAIDs may additionally increase the risk of stroke.…”

Influence of Selective Serotonin Reuptake Inhibitors on Bleeding Risk in Patients with Severe Thrombocytopenia after Chemotherapy: A Retrospective Study

“…Apart from the effect on serotonin in platelets, other mechanisms responsible for increased bleeding risk in patients on SSRI treatment have been discussed [14]. For example, the increased gastrointestinal bleeding risk may be caused by enhanced gastric acid secretion (due to SSRI use) rather than the influence of thrombocyte aggregation.…”

Gastric Barrier Function and Toxic Damage

“…Inhibition of serotonin transporters is one of them [40]. Platelets release serotonin at sites of bleeding and vascular damage; however, they do not synthesize serotonin themselves and acquire it from the blood and store it [40,41]. Because of inhibition of serotonin transport and uptake, SSRIs may also worsen the bleeding caused by ASA and clopidogrel [40,41].…”

“…There are few possible mechanisms responsible for this effect. Inhibition of serotonin transporters is one of them [40]. Platelets release serotonin at sites of bleeding and vascular damage; however, they do not synthesize serotonin themselves and acquire it from the blood and store it [40,41].…”