Vascular consequences of antidepressant use: Balancing neuropsychiatric benefits and hemostatic risks

The prevalence of depressive disorders continues to increase, representing a leading contributor to global disability and disease burden. Although antidepressants remain the cornerstone of treatment, their variable efficacy and adverse effects have drawn increasing attention. Vascular homeostasis is tightly regulated by the dynamic balance between coagulation and fibrinolysis, processes essential for maintaining physiological integrity. Emerging evidence indicates that antidepressants, beyond their effects on mood and cognition, may modulate endothelial function, platelet activity, and the coagulation-fibrinolysis system through multiple biological pathways. These interactions suggest a previously underappreciated link between antidepressant therapy and vascular regulation. Elucidating the molecular mechanisms by which antidepressants influence vascular homeostasis may enhance understanding of the systemic pathophysiology of depression and inform safer, more individualized treatment strategies. This review systematically summarizes the effects of different classes of antidepressants on coagulation and fibrinolytic systems, with a focus on their molecular mechanisms and potential clinical implications.