Psychiatry and Clinical Psychopharmacology

Psychopharmacology Ecchymoses related to paroxetine and sertraline

Psychiatry and Clinical Psychopharmacology 2013; 23: Supplement S213-S213
Read: 835 Published: 18 March 2021

Although selective serotonin reuptake inhibitors (SSRIs) present a safety profile, some case reports associate SSRIs with an increased risk of bleeding. We report a case of paroxetine and sertraline associated ecchymoses in a female patient with depression. Mrs A is a 35-year-old female, who was treated for depression with a regimen of paroxetine 15 mg/day. Two weeks after the initiation of the treatment, she noted the ecchymoses on her legs and hips. She had no previous history of abnormal bleeding, and denied trauma or other medications. Her hematological investigations, including a complete coagulation profile, were normal. Possibility of paroxetine related ecchymoses was suggested. Paroxetine was discontinued and the symptoms resolved. After 2 weeks, she was started on sertraline 50 mg/day. Twenty days later, several ecchymoses appeared on her legs again. Sertraline was stopped and the patient returned for evaluation 5 days later. She was switched to escitalopram 10mg/day without recurrence of ecchymoses for the last 2 months. This case was diagnosed as ecchymoses associated with paroxetine and sertraline. SSRIs act on the serotonin transporter located on the platelet cell membranes. This leads to a depletion of serotonin in the platelets, which decreases coagulation and may lead to a predisposition of bleeding.

EISSN 2475-0581