Upper gastrointestinal bleeding in a patient receiving selective serotonin reuptake inhibitor

An older woman presented to the hospital with abdominal pain and subsequently had three episodes of melaena, requiring blood transfusions. She was known to suffer with severe depression and was on high-dose fluoxetine. Gastroscopy and colonoscopy failed to reveal an underlying cause for gastrointestinal (GI) bleeding. Possibility of high-dose selective serotonin reuptake inhibitors causing GI bleed was raised. Fluoxetine was discontinued and the patient was commenced on mirtazapine. The patient had no further GI bleeding and had significant improvement in haemoglobin.