Psycho-Babble Medication | about biological treatments | Framed
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Posted by Sunnely on September 20, 2000, at 19:47:08

In reply to ADVICE BADLY NEEDED!, posted by MJK on September 20, 2000, at 0:27:52

> Now comes the problem - although I have always had erratic sleep patterns, about six months ago, I stopped sleeping (if I was able to get more than two hours a night, I was happy) and I also started bruising very easily. Unfortunately, sleep deprevation comes with its own set of side-effects (as does walking around all bruised) and, at the urging of my spouse, I mentioned these problems to another doctor who has been treating my son for the past year for ODD/ADD/LD disorders (this doc is very well reputed and helped, immensely, with my son). He felt that my problems stemmed from the prolonged use of Prozac and that the Dexadrine was extremely dangerous and highly addictive. He and my husband made me so nervous about the Dexadrine (especially considering my history), that I stopped taking it about six weeks ago


Hello MJK,

I can't tell you for sure what you should do about your meds as only you and your doctor can decide on this matter. But I thought I would post a response to help you with your decision.

Case reports suggest that serotonergic antidepressants such as the SSRIs (Prozac, Paxil, Zoloft, Luvox, Celexa) and others (e.g., Effexor) can lead to increased bleeding, such as ecchymoses (spontaneous bruising), epistaxis (spontaneous nose bleeding), and prolonged or heavy menstrual bleeding. Rarely, they have caused gastrointestinal, genitourinary, or intracranial bleeding.

Among the SSRIs, more cases have been reported with fluoxetine (Prozac) than others. The adverse reactions frequently reported include ecchymoses (bruising), epistaxis (nose bleeding), bleeding internal hemorrhoids, menorrhagia (heavy menstrual flow), gastrointestinal ulcerations with hemorrhage, petechiae (reddish small skin spots), and melena (blackish stool).

The mechanism as to how these reactions occur seems to be related to the effect of the SSRIs on serotonin. Under normal circumstances, platelets (blood particles responsible for clotting) release serotonin at the site of vascular tears, leading to further platelet aggregation and vasodilation (blood vessels enlarge). This permits sealing of the tear stopping the bleeding. It appears that the SSRIs block the reuptake of serotonin into the platelets which lead to decreased serotonin to be released by the platelets into the site of bleeding, impairing the clotting effect. Most oftentimes, dose reduction or discontinuation of the SSRI resolves this problem.

If you are on SSRI, you should also avoid the use of aspirin or NSAIDs (e.g., Motrin, Advil, etc.) as the concurrent use of these meds can produce a sharp increase in the risk for bleeding. You should also be aware that certain herbal preparations may interfere with clotting mechanism and may increase risk of bleeding especially if combined with the serotonin-boosting drugs, aspirin, NSAIDs, and warfarin (Coumadin). These herbs include chamomile, feverfew, garlic, ginger, gingko, and ginseng.

The following case reports exemplify bleeding tendencies from use of serotonin-boosting antidepressants.

1] A 19-year-old woman developed spontaneous bruising and 3 ecchymoses on her arms a week after beginning Effexor, 50 mg twice a day. She had no personal or family history of any bleeding disorder nor any other medical condition. Her clotting factors and platelet counts were noted to be within normal limits. Once Effexor was stopped, her ecchymoses and easy bruising resolved over 10 days.

2] Abnormal bleeding occurred in 5 patients, aged 8-15 years, within 1 week to 3 months after starting on 25-100 mg per day of sertraline (Zoloft). Four patients experienced frequent episodes of nosebleed, and another had bruising on the lower legs. The complications resolved after discontinuation or dosage reduction of sertraline; in 1 patient, bleeding reappeared 2 weeks after sertraline was reintroduced. Another patient was treated with an alternative SSRI, with no recurrence of bleeding. In 3 patients, bleeding parameters assessed during treatment were normal.


1. Antidepressants and Bleeding. In: Biological Therapies in Psychiatry Newsletter, AJ Gelenberg, MD (editor), April 1998.

2. Do Antidepressants Increase Upper GI Bleeding? In: Biological Therapies in Psychiatry, AJ Gelenberg MD (editor), July 2000.

3. Potential Bleeding and SSRIs. In: Psychiatry Drug Alerts, May 2000.

4. Miller LG: Herbal Medicinals: Selected clinical considerations focusing on known or potential drug-herb interactions. Archives of Internal Medicine, November 9, 1998.

5. Wong AC, Smith M, Boon HS: Herbal remedies in psychiatric practice. Archives of General Psychiatry 1998;55:1033-1044.




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