An SSRI can interfere with the serotonin transporter in platelets, eventually causing serotonin depletion and platelet dysfunction, which may be associated with an increased risk for bleeding.
Gastroprotection may involve therapy with one of the following:
(1) H2 antagonist
(2) proton pump inhibitor
(3) misoprostil
Additional measures:
(1) reduce dosage or stop interacting drugs if possible
(2) select an SSRI with a low affinity for the serotonin transporter
Indications for gastroprotection:
(1) concurrent therapy with an NSAID, including aspirin
(2) concurrent therapy with warfarin, corticosteroids or other medication associated with an increased risk of bleeding
(3) age > 65 years
(4) recent history of peptic ulcer or gastrointestinal bleeding
(5) debilitated state
Limitations:
• No studies have demonstrated that gastroprotection reduces the risk of bleeding in patients taking SSRIs (page 530).
