Re: Worried about being on SSRI's for so long and possible dangers of long term use.
Originally Posted by
owainm
Do you have any further info on why the bleeding risks are highest in the the first 30 days of ssri treatment? Is there an initial effect which the body then adjusts to resulting in a reduced platelet count which the body then readjusts to.
The risk isn't any higher, just that those susceptible are likely to experience problems within 30 days (or within 30 days of a dose increase). If you don't have an issue then you're unlikely to later.
Also is there any evidence that a bleeding risk is increased with duration of ssri treatment,
No. The main risk is taking other anticoagulants such as NSAIDs and warfarin, but maybe not NOAK anticoagulants such as rivaroxaban (which I'm currently on for DVT in addition to a very large dose of a moderately serotonergic TCA). There are a number of potent anticoagulant supplements such as fish oil, ginkgo biloba and ginseng which need to be treated with caution too. Google for a full list.
Bottom line: if you were on SSRIs for over a decade without problems you are very unlikely to have any in the future, especially given fluoxetine is a less potent serotonin reuptake inhibitor than paroxetine. HA is a much greater risk to your wellbeing.
or does the body just keep producing platelets at the same level after the initial 30 day impact.
As per above, there is no heightened risk for the initial 30 days. Serotonergic ADs don't reduce platelet count. Serotonin has a number of roles in wound repair. Significant quantities of it are stored in platelets for release into blood vessel breeches to initiate blood coagulation, constrict the blood vessel and stimulate tissue cell growth. The platelets take up serotonin from plasma with the same serotonin transporters (SERT) as neurons use to reuptake it from synapses after cell depolarisation (firing) and SSRIs, etc, inhibit them too. These ADs also reduce the amount of serotonin circulating in the blood.
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The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.