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Case: A 44 year old, university graduate, married male with 2 children was diagnosed with a first episode major depressive disorder and no abnormalities were observed in the routine tests, including the total blood count test carried out prior to commencing drug therapy. Afterwards the patient was prescribed şuoxetine and the daily total drug dose was set at 10 mg for the first week of treatment and 20 mg for the following 3 weeks. During the first follow up visit after thirty days, it was observed that the patient had gone into a total remission and no change was made in the pharmacotherapy. However, it was learned that thrombocytopenia was detected in the total blood count test requested by the family doctor because of a suspicion of a urinary tract infection. Since no pathology that could account for the thrombocytopenia that was detected by a hematology expert following standard consultation and further tests, the patient was transferred back to us with a suspicion of şuoxetine induced thrombocytopenia. Fluoxetine was immediately discontinued and replaced with reboxetine and similarly reboxetine was prescribed as 4 mg/day for the first week and as 8 mg/day after the first week. The thrombocytopenia of the patient went into total remission within 7 days and no problem was observed during the total blood count tests for the next 6 months. Even though the most common side effects of şuoxetine are nausea, nervousness, and insomnia, side effects of the hematological system have also been noted. To this end, there are publications which suggest possible negative effects on the number and function of thrombocytes. It is thought that the mechanism behind these hemostasis related side effects of şuoxetine is the depletion of serotonin stores by preventing the reuptake of serotonin into thrombocytes. Starting from this hypothesis, the presumption is that reboxetine, which is a pure noradrenaline reuptake inhibitor, will have no effect on these processes. In fact, there have been no reports that relate reboxetine with thrombocytopenia and/or thrombocyte functional disorders. However it should be clarified with further studies whether this is purely coincidental or if reboxetine has no effect on serotonergic systems.
Conclusion: Reboxetine may be a good alternative for patients with thrombocytopenia and/or with functional thrombocyte disorders in the treatment of major depressive disorders. However, more research is required in order to reach more certain conclusions.
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3. Halperin D, Reber G. Inşuence of antidepressants on hemostasis. Dialogues Clin Neurosci 2007; 9(1):47-59
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