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[Ecchymosis associated with the
use of fluoxetine: case report]
Mirsal H, Kalyoncu A, Pektas O.
Tip Fak, Psikiyatri AD, Istanbul.
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. CASE SUMMARY: 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
PMID: 12794649 [PubMed]