Use of Selective Serotonin Reuptake Inhibitors and Risk of Upper Gastrointestinal Tract Bleeding

Abstract

DURING THE 1990s, the newer more receptor-selective antidepressive agents were used increasingly, partly because of their relatively few adverse effects and low toxicity. Several clinical reports have indicated an association between use of all types of the selective serotonin reuptake inhibitors (SSRIs) and bleeding disorders, ranging from prolonged bleeding time, ecchymoses, purpura, and epistaxis^1-10 to more serious conditions, such as gastrointestinal (GI) tract, genitourinary tract, and intracranial bleeding.^1,11 Release of serotonin by platelets plays an important role in hemostasis, and serotonin is taken up from the blood stream by serotonin transporters, similar to those transporting serotonin in the brain.¹² Because platelets are not capable of synthesizing serotonin, depletion of serotonin stores could induce hemorrhagic complications. The older antidepressants, the tricyclic and tetracyclic agents, have differing degrees of selectivity on the serotonin receptor relative to the other monoamine receptors,¹³ and some of them may also interfere with hemostatic function.