Antidepressants that inhibit platelet reuptake of 5-HT cause a platelet 5-HT depletion. This can inhibit 5-HTinduced platelet

aggregation amplification. Patients suffering from Adriamycin cost bleeding complications during antidepressant treatment may have a mild pre-existing platelet disorder or a modified platelet serotonergic response amplified by Inhibitors,research,lifescience,medical depletion of 5-HT stocks57; autoimmune mechanisms may also be involved.50 Different types of studies were performed, from case reports to epidemiological studies and prospective laboratory studies comparing subjects and controls receiving antidepressants. These studies did not lead to the same conclusions. A causal association between use of antidepressants, especially Inhibitors,research,lifescience,medical SSRIs, and abnormal bleeding or need for transfusion during surgical procedures has been found in retrospective studies.54-56,58-61 The main observation concerns a relationship between the type of antidepressant

drug and the risk of bleeding complications. The risk of upper gastrointestinal bleeding was twice as high for SSRIs than for other antidepressant drugs.55 The risk of upper gastrointestinal bleeding in elderly and depressed patients increased with antidepressants having the greatest extent of inhibition of 5-HT reuptake.56 Similarly, Inhibitors,research,lifescience,medical a significant association between the degree of 5-HT reuptake Inhibition by antidepressants and the risk of hospital admission for abnormal bleeding as primary diagnosis was found.59 in these studies, antidepressants were classified according to Inhibitors,research,lifescience,medical their degree of 5-HT reuptake Inhibition according to pharmacological studies.62,63 Blood transfusion require? ments during surgery was Increased for SRI antidepressant users compared with nonusers, which was not the case for nonserotonerglc antidepressant users.60 Upper gastrointestinal bleeding risk was found to be 12.2 times greater than expected when there was a concomitant use of SSRIs and NSAIDs.54 In the prospective

laboratory studies mentioned, the results are heterogenous. Indeed, some studies found changes in given laboratory tests which were normal in other studies. Some studies failed to show any Inhibitors,research,lifescience,medical much modlflca? tion in measured hemostasis markers.28,33,34 Otherwise, decrease in platelet/plasma 5-HT level and diminution of 5-HT-lnduced aggregation are the markers which were more often modified upon antldepresslve treatment, in line with the central role of this neurotransmitter in primary hemostasis.9,26,30 Thus, prospective studies clearly Indicate that antidepressants modify primary hemostasis. However, the configuration and the extent of these changes remains unspecified. Most case reports of abnormal bleeding associated with the use of antidepressants that have failed to demonstrate perturbations in hemostasis concern the use of antidepressants with high degree of Inhibition of 5-HT reuptake,45,57,64,76 or, to a lesser extent, antidepressants with a mild degree of Inhibition of 5-HT reuptake.