Abstract
The risk of abnormal bleeding with serotonin reuptake inhibitors has been known, but there is insufficient evidence base to guide pharmacological treatment of anxiety in patients with underlying haematological conditions. The following case report is about a 50-year-old female with generalized anxiety disorder, social phobia, obsessive compulsive disorder, and alcohol abuse where pharmacological treatment of anxiety symptoms has been difficult as it would lead to bruising due to the patient's underlying qualitative platelet dysfunction. Treatment with venlafaxine, citalopram, escitalopram, and clomipramine resulted in improvement and anxiety symptoms, as well as reduction in alcohol use, but pharmacological treatment has to be discontinued because of bruising and hematomas. In view of an active substance use disorder, benzodiazepines were avoided as a treatment option. The patient's anxiety symptoms and comorbid alcohol abuse responded well to pharmacological treatment with buspirone which gradually titrated up to a dose of 30 mg BID. Patient was followed for around a six-month period while she was on buspirone before being discharged to family doctor's care. Buspirone is unlikely to have a significant effect on platelet serotonin transponder and could be an effective alternative for pharmacological treatment of anxiety in patients with a bleeding diathesis.
Highlights
The risk of abnormal bleeding with serotonin reuptake inhibitors (SSRIs) has been known since a landmark British study demonstrated the association between upper gastrointestinal bleeding and SSRIs [1]
There is insufficient evidence base to guide the pharmacological treatment of anxiety in a patient with underlying haematological conditions resulting in platelet dysfunction, which makes the following case significant
The average duration of antidepressant use that leads to bleeding is consistent with current evidence
Summary
The risk of abnormal bleeding with serotonin reuptake inhibitors (SSRIs) has been known since a landmark British study demonstrated the association between upper gastrointestinal bleeding and SSRIs [1]. There has been evidence to suggest that antidepressant use can lead to hospitalization for abnormal bleeding. The risk of bleeding is increased if there is concomitant use of SSRIs with antiplatelet drugs [3]. Blockade of serotonin reuptake by platelets, leading to subsequent depletion interfering with platelet aggregation, has been postulated to increase the risk of abnormal bleeding [4]. The patient complained of excessive worrying about “something dreadful happening all the time,” feeling tense, inability to relax, and irritability. These psychological symptoms of anxiety were accompanied by neck and shoulder muscle aches, teeth clenching, sleep difficulties mainly consisting of initial insomnia, and impaired concentration
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