Delayed pressure urticaria treated with the selective serotonin reuptake inhibitor escitalopram

There is increasing evidence of platelet activation and systemic inflammation in chronic spontaneous urticaria and delayed pressure urticaria (DPU). Inflammation may be central to understanding the high comorbidity of depression and anxiety in patients with chronic urticaria (CU). We report a case of DPU and depression in a patient, which responded favourably to treatment with the selective serotonin reuptake inhibitor (SSRI) escitalopram. Sustained administration of SSRIs is associated with downregulation of serotonin transporters/receptors and depletion of platelet stored serotonin, which may reduce the ability of platelets to aggregate after thrombotic triggers. SSRIs are easier to manage and have significantly less disturbing adverse effects and cardiotoxicity than the tricyclic antidepressants (TCAs). SSRIs may represent an alternative to the traditional use of TCAs in treatment of CU.