Bruising on Sertraline? (Or other SSRIs)

Hi

I originally commented on an old thread on the Sertraline forum but got no replies so figured I'd start a new thread here and hopefully reach a wider audience.

I have been on Sertraline for 4 weeks for crippling health anxiety. 5 days ago, I suddenly came out in about half a dozen purple bruises on my arms & legs, a couple of them were huge! It was bizarre, they literally came up simultaneously over the course of one afternoon/evening. Unexplained bruising is listed as a serious but rare side effect of Sertraline (and other similar drugs such as Prozac & Citalopram) and the NHS site says you should seek immediate medical attention. I spoke to my GP who sent me to A&E. I was petrified! 5 hours and several blood tests later they said all was fine so likely Sertraline was to blame. I had to show A&E doc NHS site though as she'd not heard of this effect personally, only that it can cause GI bleeding. I was told to come off the drug straightaway. They also checked my urine and found a trace of blood. My period was due (and did actually start the next morning) so said likely cause but to ask GP to recheck urine if it didn't.

However, 2 days later I received a text with an appointment for a CT scan on thorax/abdomen/pelvis which sent me spiralling again. My rational brain is telling me they reviewed my notes and have decided to check for internal bleeding regardless as a precaution but my health anxiety says otherwise! Annoyingly, I cannot make the appointment which is scheduled for the end of this week so have contacted them to reschedule, awaiting response.

I came off the drug immediately and fingers crossed, no more bruises since and the original ones are fading fast. I've now missed 4 doses of Sertraline (was on 50mg) and touch wood no horrible side effects so far.

Has anyone else experienced this side effect? Seems it's pretty rare, given A&E doctor had to look it up, so don't want to panic anyone on these drugs.

I'm of course worrying what else it could be if Sertraline not to blame - was convinced I had leukaemia while sat in A&E but my blood count, including platelet count and blood clotting were "in the black" according to doctor, so assume nothing really bad. Apart from having anxiety, I feel perfectly well.

Sorry this is so long but would be grateful for any experiences.

Thank you x

Hi

This is just a courtesy reply to let you know that your post was moved from its original place to a sub-forum that is more relevant to your issue.

This is nothing personal - it just enables us to keep posts about the same problems in the relevant forums so other members with any experience with the issues can find them more easily.

Please also read this post:

http://www.nomorepanic.co.uk/showthread.php?t=213239

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Originally Posted by Dobbiedoo

5 days ago, I suddenly came out in about half a dozen purple bruises on my arms & legs, a couple of them were huge! It was bizarre, they literally came up simultaneously over the course of one afternoon/evening.

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All serotonergic ADs are mild anticoagulants. Blood platelets hold significant quantities of serotonin which are released into injury sites to initiate clotting and healing. Serotonin also helps regulate blood vessel tone, constriction and dilation. SSRIs and other serotonergic ADs reduce the amount of serotonin held in the platelets which causes the anticoagulation effect and may dilate blood vessels which can increase the risk of bruising.

Were you also taking any other medication, prescription or over-the-counter which affect coagulation such as warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto), aspirin, ibuprofen, naproxen, ginkgo biloba, ginger, grape seed extract, etc?

Sertraline seems to be the most serotonergic of the SSRIs so your experience doesn't necessarily rule the others out.

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I've now missed 4 doses of Sertraline (was on 50mg)

...I came off the drug immediately and fingers crossed, no more bruises since and the original ones are fading fast.

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That's a fairly quick response for bruises. I'm wondering if this might have been an allergic reaction and not bruises. ADs can trigger reddish to purple skin rashes, hives, lumps and spots, especially during the first few weeks.

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and touch wood no horrible side effects so far.

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Withdrawal symptoms are very unlikely after taking an AD for only 5 days. Sertraline plasma levels would have only just stabilised when you stopped taking it.

Thanks just seen this. I was on Sertraline for 4 weeks when the bruises appeared, not 5 days. Now been off 6 weeks. For about 3 weeks after stopping, I continued to get a few minor bruises that healed very quickly. I got a couple on my shin earlier this week which freaked me then I remembered knocking myself there with a shopping basket the day before (not particularly hard though but enough to register with me) so hopefully that's why.

Not had the CT results so am plucking up courage to call GP tomorrow. They only tend to call you if there's a problem and it's been 3 weeks since the scan so fingers crossed (was told GP would have results in 2 weeks)

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Originally Posted by Dobbiedoo

Thanks just seen this. I was on Sertraline for 4 weeks when the bruises appeared, not 5 days.

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:oopsie: :emot-fail::buttkick: :blush:

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Now been off 6 weeks. For about 3 weeks after stopping, I continued to get a few minor bruises that healed very quickly.

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Sertraline would have been completely out of your system within 5 days and it should only have taken a few more for sertraline to be restored to pre treatment levels in platelets.

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Not had the CT results so am plucking up courage to call GP tomorrow. They only tend to call you if there's a problem and it's been 3 weeks since the scan so fingers crossed (was told GP would have results in 2 weeks)

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You would hope an even half way competent GP wouldn't ignore a worrying result so you're almost certainly in the clear. SSRIs don't usually cause serious bleeding problems on their own. The danger is when they are taken with other meds, or supplements which also have an anticoagulant effect, or there is a physical issue such as haemophilia, some liver diseases, or eating low vitamin K diets.

I called today for the CT results and they didn't have them despite the hospital saying the GP would have them in 2 weeks (it's been more than 3). GP Receptionist said this was typical of the hospital and usually they were nearer 6 weeks. She did say though it would definitely have been looked at and that if anything worrying is seen, the hospital calls them. I take that as a good sign but it would be good to know for sure!

I've updated on the health anxiety board but no response so far.

It's now more than 5 weeks since the ct scan and still no results so GP surgery chased the hospital for me last week. Was told 3 days ago that hospital were emailing them to GP and to give it a few days before making appointment with GP. Then, yesterday, I receive a "follow up" appointment for later this week with a doctor in the breast clinic. I'm petrified! I did see the breast clinic 8 weeks ago (3 weeks before the ct scan) and was given a mammogram & ultrasound which were all clear so certainly not expecting any follow up appointment. Can only think it's related to the ct scan, but surely nothing can have changed in just 3 weeks?!

I will be calling GP & hospital in the morning to find out what is going on and complain about their appalling communication and the anxiety it's causing me. I was never even told I was being sent for the ct or why (appointment appeared out of the blue) and now this! I also need reassurance that I won't be receiving any more unexpected appointments from other hospital departments as my mental health won't stand it!

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Originally Posted by Dobbiedoo

yesterday, I receive a "follow up" appointment for later this week with a doctor in the breast clinic. I'm petrified! I did see the breast clinic 8 weeks ago (3 weeks before the ct scan) and was given a mammogram & ultrasound which were all clear so certainly not expecting any follow up appointment. Can only think it's related to the ct scan, but surely nothing can have changed in just 3 weeks?!

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It could also be unrelated, or simply be a clerical error. Even if it is what you fear a clear mammogram and ultrasound sound likely means the CT scan picked up something very small which increases the odds of a false positive and worse case the smaller a malignancy is when detected the easier it is to remove and the greater the odds of the surgery being curative. The 5 year survival rate for localised breast cancer is 99%.

It was a mistake!!! Doctor at breast clinic had ordered the scan for me instead of another patient! Nothing was found on the scan. The "follow up" appointment was for him to explain and apologise. Because I'd also been to a&e the following day, I assumed it was arranged by them, but even that was strange as they never mentioned doing a scan when I was there. It was an unfortunate catalogue of events that led me to go for a scan that I didn't need.

While I'm relieved, I'm also upset and angry at the weeks of stress and anguish this has caused me.

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Originally Posted by Dobbiedoo

It was a mistake!!!

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This is very good news!! :yesyes: :yahoo:

The change of events did seem odd so I'm not totally surprised, but a posterior or two need have a swift application of boot leather, imo! :ohmy: