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Selective Serotonin Reuptake Inhibitor (SSRI) Bleeding Risk: Considerations for the Consult-Liaison Psychiatrist

  • COMPLEX MEDICAL-PSYCHIATRIC ISSUES (MB RIBA, SECTION EDITOR)
  • Published:
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Abstract

Purpose of Review

To present a clinically oriented review of selective serotonin reuptake inhibitor (SSRI)-related bleeding issues commonly addressed by consult-liaison psychiatrists.

Recent Findings

Concomitant medical, surgical, or hospital-based conditions exacerbate the risk of SSRI-related bleeding even though a review of the literature suggests it is only marginally elevated. Psychiatrists and other clinicians need to consider these conditions along with antidepressant benefits when answering the question: to start, hold, continue, or change the antidepressant?

Summary

Where an evidence base is limited, mechanistic understanding may help consult-liaison psychiatrists navigate this terrain and collaborate with other medical specialties on responsible antidepressant management. Most often, the risk is cumulative; data are not directly applicable to complex clinical situations. This review incorporates a hematologic perspective and approach to bleeding risk assessment along with extant data on SSRI-induced bleeding risk ad specific medical conditions.

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Data Availability

Data are available upon request. 

Abbreviations

CVA:

Cerebrovascular accident (stroke)

EtOH:

Ethanol or alcohol

HTN:

Hypertension

PT:

Prothrombin time

PTT:

Partial thromboplatin time

SSRI:

Selective serotonin reuptake inhibitor

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Acknowledgements

The editors would like to thank Dr. Madhavi-Latha Nagalla for taking the time to review this manuscript. The authors would like to thank the Academy of Consultation-Liaison Psychiatry and its special interest group, Palliative Care & Psycho-Oncology.

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Authors and Affiliations

  1. Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA

    Daniel McFarland

  2. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA

    Daniel McFarland

  3. Department of Psychiatry, Westmead Hospital, Westmead, NSW, Australia

    Dale Merchant

  4. Department of Consultation-Liaison Psychiatry, Concord Repatriation General Hospital, Sydney, NSW, Australia

    Dale Merchant & Andrew Gleason

  5. Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Abhisek Khandai

  6. Department of Psychiatry, University of California Los Angeles, Los Angeles, CA, USA

    Mona Mojtahedzadeh

  7. Simms-Mann Center for Integrative Oncology, University of California Los Angeles, Los Angeles, CA, USA

    Mona Mojtahedzadeh

  8. Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA

    Omar Ghosn & Jeremy Hirst

  9. Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, USA

    Hermioni Amonoo

  10. Department of Psychosocial Oncology, Dana-Farber Cancer Center, Boston, MA, USA

    Hermioni Amonoo

  11. Department of Psychiatry, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA

    Depti Chopra

  12. Department of Psychiatry, Mayo Clinic, Jacksonville, FL, USA

    Shehzad Niazi

  13. Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Jennifer Brandstetter

  14. Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia

    Andrew Gleason

  15. Department of Psychiatry, Ascension Seton Medical Center, Austin, TX, USA

    Garrett Key

  16. Department of Psychiatry, Moffitt Cancer Center, Tampa, FL, USA

    Barbara Lubrano di Ciccone

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  1. Daniel McFarland
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Contributions

We had multiple roles in writing the manuscript including the conception, design, acquisition, analysis, and interpretation of the data.

Corresponding author

Correspondence to Daniel McFarland.

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Additionally, each author met each of the authorship requirements as stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals.

Conflict of Interest

Daniel McFarland, Dale Merchant, Abhisek Khandai, Mona Mojtahedzadeh, Omar Ghosn, Jeremy Hirst, Depti Chopra, Shehzad Niazi, Jennifer Brandstetter, Andrew Gleason, Garrett Key, and Barbara Lubrano di Cicconeeach declare no potential conflicts of interest. Hermioni Amonoo has received a grant from the National Cancer Institute.

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McFarland, D., Merchant, D., Khandai, A. et al. Selective Serotonin Reuptake Inhibitor (SSRI) Bleeding Risk: Considerations for the Consult-Liaison Psychiatrist. Curr Psychiatry Rep 25, 113–124 (2023). https://doi.org/10.1007/s11920-023-01411-1

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