Selective serotonin reuptake inhibitors in the context of hepatitis C infection: reexamining the risks of bleeding.
OBJECTIVE
Selective serotonin reuptake inhibitors (SSRIs) are used to treat interferon-associated depression in patients receiving hepatitis C virus therapy. Prior studies have cautioned against the combined use of SSRIs and interferon due to increased risk of hemorrhage. Given the morbidity of depression and its impact on interferon compliance, we sought to reexamine the data.


METHODS
In a retrospective analysis of our database of hepatitis C virus patients, a consecutive series of 303 patients (receiving treatment between January 2001 and January 2005) were evaluated for any evidence of bleeding. On the basis of our standard practice of care, patients were treated prophylactically with antidepressants for 3 to 4 weeks before beginning combination therapy with interferon and ribavirin. Patients were evaluated every 4 weeks during antiviral treatment with physical examinations and complete blood cell counts with differentials and platelets.


RESULTS
The overall rate of bleeding in our study was 0.3%, representing a single case of hemophilia.


CONCLUSIONS
The bleeding risk of SSRIs is lower than previously reported.
Department of Psychiatry and Psychology, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA. martin.kariann@mayo.edu
Kari A
KA
Martin
Lois E
LE
Krahn
Vijayan
V
Balan
Marianne J
MJ
Rosati
D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003866:Depressive Disorder / Q000139:chemically induced / Q000188:drug therapy*; D004347:Drug Interactions; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use
D000998:Antiviral Agents; D007372:Interferons; D012254:Ribavirin; D017367:Selective Serotonin Reuptake Inhibitors