[Ecchymosis associated with the use of fluoxetine: case report]

Selective Serotonin Reuptake Inhibitors (SSRI) are well established in psychopharmacological therapy. SSRIs have been shown to be very effective in the treatment of depressive, anxiety and obsessive-compulsive disorders and have a favorable side effect profile. Although bleeding events are rare, there may be potentially severe hematologic complications following treatment with SSRIs. Fluoxetine has been reported to cause ecchymosis, bleeding and other hematologic problems. The aim of this article is to report a case of suspected fluoxetine-induced ecchymosis and to review the literature about this adverse effect.

A 23-year-old woman was diagnosed with depressive disorder according to DSM-IV criteria and treated with fluoxetine 20 mg/day. After treatment for 10 weeks, the patient reported ecchymosis without any trauma. Her complete blood cell count, prothrombin time, partial thromboplastin time, bleeding time and other hematologic screening tests were within the normal limits. Her complete physical examination was also normal. After the medication was discontinued for 4 weeks, ecchymosis disappeared. A month later, the patient took fluoxetine for a week, and then the ecchymosis restarted. Fluoxetine was suspected to be the cause of these lesions. SSRIs cause these side effects by disrupting the normal platelet aggregation process through the blockade of serotonin uptake into platelets. For this reason, caution is recommended when using fluoxetine and other SSRIs in patients with thrombocytopenia or suspected platelet dysfunction.