Publication:

Selective serotonin reuptake inhibitors and the risk of bleeding

Background Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed agents for various conditions in general psychiatry. There is a strong consensus that blockade of serotonin reuptake affects primary hemostasis, namely platelet activity, thus resulting in a bleeding tendency. Considering that SSRIs are commonly prescribed, this study was conducted to assess if they were associated with an increased risk of bleeding.

Methods This was a prospective, open-label study of 30 patients attending the Psychiatry out-patient department, Dr. B. R. Ambedkar Medical College, Bangalore who satisfied DSM-IV criteria for a primary diagnosis of depression, treated with SSRIs. Bleeding time, clotting time, prothrombin time, partial thromboplastin time and platelet count were assessed at baseline and at the end of 6 weeks of treatment or occurrence of bleeding symptom.

Results The patients aged between 18-55 years of whom 21 were females, were treated with an SSRI (fluoxetine 12, escitalopram 12 and sertraline 6 patients). Six patients had overt symptoms of bleeding (upper gastrointestinal bleeding (hematemesis) 4; epistaxis 2 and petechiae 2) of whom one patient gave a history of both hematemesis and petechiae and another of hematemesis and epistaxis. The average day after treatment beginning, on which patients reported with bleeding was 30.33 (26-40 days). There was a significant increase in the bleeding time (p=0.028) and clotting time (p=0.042), implying derangement in platelet aggregation. There was no significant change in the other parameters.

Conclusion Treatment with SSRIs increases the risk of bleeding. However, large, randomized controlled trials are required to re-affirm these findings.