Drug and Therapeutics Bulletin 2004;42:17-18; doi:10.1136/dtb.2004.42317
Copyright © 2004 by the BMJ Publishing Group Ltd.

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Do SSRIs cause gastrointestinal bleeding?

Relevant BNF section: 4.3.3

Selective serotonin re-uptake inhibitor antidepressants (SSRIs) can inhibit uptake, and therefore storage, of serotonin by platelets. This is significant because release of serotonin from platelets augments their aggregation; so use of SSRIs could, in theory, predispose patients to bleeding disorders.^1–3 Case reports have suggested a link between SSRIs and easy bruising, nosebleeds, menorrhagia, petechial, ocular, small bowel, rectal and cerebral haemorrhages, and a prolonged bleeding time.^4–11 Also, the summaries of product characteristics (SPCs) for all SSRIs include warnings about use in patients with a history of bleeding disorders or concomitant use with drugs known to affect platelet function.^12–17 Here we review the risk of gastrointestinal bleeding associated with the use of SSRIs.