Antiplatelet effects of antidepressant treatment: A randomized comparison between escitalopram and nortriptyline

Flöck, A; Zobel, Astrid; Bauriedel, Gerhard; Tuleta, Izabela; Hammerstingl, Christoph; Höfels, Susanne; Schuhmacher, Anna; Maier, Wolfgang; Nickenig, Georg; Skowasch, Dirk

doi:10.1016/j.thromres.2010.04.020

Cited by 23 publications

(21 citation statements)

References 28 publications

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“…It is possible that 4 weeks was an insufficient treatment period; previous research showing FMD improvement with SSRI treatment used a treatment period of 20 weeks. 22 Unlike previous research, [40][41][42] we did not observe an impact of SSRI treatment on platelet aggregation. However, our results indicated that another marker of platelet function, platelet NO production, decreased considerably with SSRI treatment, with a significant 21% drop from pre-to posttreatment.…”

Section: Discussioncontrasting

confidence: 99%

Selective Serotonin Reuptake Inhibitors and Endothelial Function in Women

Hantsoo

Czarkowski

Child

et al. 2014

Journal of Women's Health

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Background: Among women worldwide, major depression (MDD) and heart disease rank first and second, respectively, in burden of disease. Although selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed, possible inhibition of nitric oxide (NO) function has caused concerns about their effects on protective vascular mechanisms. Our study aimed to determine the effect of SSRIs on flow-mediated vascular dilatation (FMD), platelet aggregation, and platelet NO production among women. Methods: Women (n = 28) without known cardiovascular disease were recruited prior to undergoing SSRI treatment for MDD, postpartum depression (PPD), or premenstrual dysphoric disorder (PMDD). Symptoms were quantified using the Hamilton Depression/Anxiety and Beck Depression scales. FMD, platelet aggregation, and platelet NO production were measured before and after 1 month of SSRI (sertraline, fluoxetine, or paroxetine) therapy. Results: Depression and anxiety symptoms decreased significantly with SSRI treatment ( ps < 0.01). FMD and platelet aggregation did not differ between pre-and posttreatment, although FMD rose to the normal range ( ‡ 8%) in two of three women with abnormal FMD prior to SSRI treatment. We observed a 21% decrease ( p = 0.024) in platelet NO production. Conclusions: SSRI treatment had little effect on FMD or platelet aggregation. The health impact of decreased NO production is unclear, particularly in this relatively young group of women without cardiovascular disease, but should be considered in future studies focusing on SSRI safety in patients with cardiovascular disease.

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Section: Discussioncontrasting

confidence: 99%

Selective Serotonin Reuptake Inhibitors and Endothelial Function in Women

Hantsoo

Czarkowski

Child

et al. 2014

Journal of Women's Health

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“…That is, the negative symptoms of depression and schizophrenia, like fatigue, may mimic those of anemia [18,34] and lead to higher rates of blood transfusion. Another possible explanation for this finding is that several medications used in the treatment of depression and schizophrenia, including selective serotonin reuptake inhibitors and antipsychotics, are associated with antiplatelet activity [35,36]. Of course, causal relationships between medications used to treat schizophrenia and depression and the requirement for blood transfusion cannot be drawn from this study, but future prospective studies should seek to determine a reason for this association.…”

Section: Discussionmentioning

confidence: 89%

The Influence of Psychiatric Comorbidity on Perioperative Outcomes Following Primary Total Hip and Knee Arthroplasty; A 17-year Analysis of the National Hospital Discharge Survey Database

Buller¹,

Klika²,

Barsoum³

2015

The Journal of Arthroplasty

122

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“…Research on depressed patients has shown that plasma levels of serotonin are reduced, platelet levels are elevated, and pro-aggregating processes are enhanced, possibly increasing the risk of cardiovascular events (Musselman et al, 2000; Bakkaloglu et al, 2008; Flock et al, 2010). …”

Section: Increased Risk Of Relapse After Antidepressant Discontinuationmentioning

confidence: 99%

Primum Non Nocere: An Evolutionary Analysis of Whether Antidepressants Do More Harm than Good

Andrews¹,

Thomson²,

Amstadter³

et al. 2012

Front. Psychology

105

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Antidepressant medications are the first-line treatment for people meeting current diagnostic criteria for major depressive disorder. Most antidepressants are designed to perturb the mechanisms that regulate the neurotransmitter serotonin – an evolutionarily ancient biochemical found in plants, animals, and fungi. Many adaptive processes evolved to be regulated by serotonin, including emotion, development, neuronal growth and death, platelet activation and the clotting process, attention, electrolyte balance, and reproduction. It is a principle of evolutionary medicine that the disruption of evolved adaptations will degrade biological functioning. Because serotonin regulates many adaptive processes, antidepressants could have many adverse health effects. For instance, while antidepressants are modestly effective in reducing depressive symptoms, they increase the brain’s susceptibility to future episodes after they have been discontinued. Contrary to a widely held belief in psychiatry, studies that purport to show that antidepressants promote neurogenesis are flawed because they all use a method that cannot, by itself, distinguish between neurogenesis and neuronal death. In fact, antidepressants cause neuronal damage and mature neurons to revert to an immature state, both of which may explain why antidepressants also cause neurons to undergo apoptosis (programmed death). Antidepressants can also cause developmental problems, they have adverse effects on sexual and romantic life, and they increase the risk of hyponatremia (low sodium in the blood plasma), bleeding, stroke, and death in the elderly. Our review supports the conclusion that antidepressants generally do more harm than good by disrupting a number of adaptive processes regulated by serotonin. However, there may be specific conditions for which their use is warranted (e.g., cancer, recovery from stroke). We conclude that altered informed consent practices and greater caution in the prescription of antidepressants are warranted.

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Antiplatelet effects of antidepressant treatment: A randomized comparison between escitalopram and nortriptyline

Cited by 23 publications

References 28 publications

Selective Serotonin Reuptake Inhibitors and Endothelial Function in Women

Selective Serotonin Reuptake Inhibitors and Endothelial Function in Women

The Influence of Psychiatric Comorbidity on Perioperative Outcomes Following Primary Total Hip and Knee Arthroplasty; A 17-year Analysis of the National Hospital Discharge Survey Database

Primum Non Nocere: An Evolutionary Analysis of Whether Antidepressants Do More Harm than Good

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