Safer Antidepressants with Bleeding Risk?
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What is the Underlying Mechanism?
SSRIs limit uptake of blood serotonin by platelets. Since platelets are unable to synthesize serotonin, this leads to a lower concentration of serotonin within the platelets, and because one of the functions of serotonin within the platelets is to promote platelet aggregation, a decreased amount of serotonin in the platelets may increase the risk of abnormal bleeding.
Q: Which Antidepressants are considered safe in patients at risk of abnormal bleeding?
Antidepressant drugs which do not inhibit the reuptake of serotonin are likely to be safe in patients at risk of abnormal bleeding. These drugs include:
- Mirtazapine
- Bupropion
- Moclobemide
- Reboxetine
References:
- Arch Intern Med. 2004;164(21):2367-2370;
- BMJ 2001;323:655
- Arch Intern Med. 2004;164(21):2367-2370
Q: What if the patient is either unable to tolerate or has contraindications for the above medications?
Q: How can you reduce the risk of upper gastrointestinal bleeding with SSRIs?
Psychiatry Education Forum Academy will answer these questions in following chapter:
Antidepressants & risk of BLEEDING: Thrombocytopenia Evaluation
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