Antidepressants

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Fluoxetine can cause early weight loss, but weight is usually recovered later in the course. (TT)

Advanced topics

SSRIs inhibit platelet aggregation, which can lead to bleeding in patients with von Willibrand desease, hemophilia, thrombocytopenia, or gastric ulcer.

• While SSRIs do not decrease platelet count, they inhibit platelet reuptake of 5-HT from serum, leading platelet 5-HT depletion.
  • 5-HT is an important pro-coagulant involved in primary hemostasis (platelet adhesion/aggregation/secretion of procagulants).
• SSRIs fluoxetine, sertraline, and paroxetine are most likely to increase bleeding time. Other antidepressants (venlafaxine, fluvoxamine, amitriptyline, imipramine and mirtazapine) impair hemostasis to a lesser degree. (Halperin 2007)
• Risk of GI bleed increases 12-fold with concominant use of SSRIs and NSAIDs (Dalton 2003)

References

Halperin, Demian, Influence of antidepressants on hemolysis. Dialogues Clin. Neurosci. 2007 9:47-59.
Dalton, SO. Use of serotonin reuptake inhibitors and risk of upper gastrointestinal tract bleeding. Arch Inter Med. 2003; 163:59-64