Abstract
Background:Serotonin plays an important role in the normal clotting phenomenon and is released by platelets. Platelets are dependent on a serotonin transporter for the uptake of serotonin, as they cannot synthesize it themselves. Selective serotonin reuptake inhibitors (SSRIs) block the uptake of serotonin into platelets and can cause problems with clotting leading to bleeding.Aim:This case report highlights the occurrence of upper gastrointestinal bleeding in the index case on initiating SSRI therapy for depression and the prompt resolution of the same on its discontinuation on two separate occasions.Conclusion:SSRIs may cause upper gastrointestinal (GI) bleeding. Physicians should be aware of the same and should try to rule out previous episodes of upper GI bleed or the presence of other risk factors which might predispose to it before prescribing SSRIs; they should also warn the patients about this potential side effect. Also, the presence of thalassemia trait in the index patient deserves special attention and needs to be explored to see if it might in any way contribute in potentiating this side effect of SSRIs.
Highlights
Serotonin is released from platelets in response to vascular injury, and promotes vasoconstriction and a change in the shape of the platelets, which leads to aggregation.[1]
Selective serotonin reuptake inhibitors (SSRIs) are commonly used in the treatment of depression because of their efficacy and a favorable safety and tolerability profile
There have been a few retrospective studies, in recent years, showing higher relative risk in cases as compared to controls.[9,10,11,12]. These studies have generally shown that the use of SSRIs is associated with increased incidence of upper gastrointestinal bleeding (GI) and that the SSRIs may play a causal role in it
Summary
Serotonin is released from platelets in response to vascular injury, and promotes vasoconstriction and a change in the shape of the platelets, which leads to aggregation.[1]. Selective Serotonin Reuptake Inhibitors (SSRIs) inhibit the serotonin transporter, which is responsible for the uptake of serotonin into platelets. It has been postulated that SSRIs would deplete platelet serotonin, leading to a reduced ability to form clots and a subsequent increase in the risk of bleeding.[2,5] This case report highlights the finding of episodes of upper gastrointestinal (GI) bleed in an inpatient on SSRI therapy for depression. Selective serotonin reuptake inhibitors (SSRIs) block the uptake of serotonin into platelets and can cause problems with clotting leading to bleeding. Physicians should be aware of the same and should try to rule out previous episodes of upper GI bleed or the presence of other risk factors which might predispose to it before prescribing SSRIs; they should warn the patients about this potential side effect.
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