Clinical Implications of Antidepressants and Associated Risk of Bleeding: A Narrative Review

Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are widely prescribed for mental health disorders. These medications, however, are linked to increased bleeding risks related to inhibition of serotonin reuptake, which impairs platelet aggregation. The present investigation explores the pharmacodynamics of antidepressants, clinical evidence of bleeding complications, and strategies to manage these risks.

While SSRIs and SNRIs pose the highest risk, tricyclic and atypical antidepressants show comparatively lower bleeding incidences. The concomitant use of anticoagulants, NSAIDs, or antiplatelet agents significantly amplifies bleeding risk. Current guidelines stress individualized risk assessment, alternative drug selection, and preventive measures, such as gastroprotective agents. Future research may offer novel approaches to mitigate bleeding while maintaining therapeutic efficacy, ensuring the safety of antidepressants in clinical practices.