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Citalopram-Induced Bleeding Due to Severe Thrombocytopenia

Received October 19, 2007; revised December 13, 2007; accepted January 2, 2008. From the Bremen Institute for Prevention Research and Social Medicine (BIPS), Dept. of Clinical Epidemiology, Bremen, Germany; and the Charité, Universitaetsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Charitéplatz 1, 10117 Berlin, Germany. Send correspondence and reprint requests to Frank Andersohn, M.D., Institute for Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, 10098 Berlin, Germany. e-mail: frank.andersohn{at}charite.de
© 2009 The Academy of Psychosomatic Medicine

BACKGROUND: In case reports and observational studies, serotonin reuptake-inhibitors (SSRIs) have been linked to an increased risk of bleeding, possibly due to platelet dysfunction as a consequence of serotonin-uptake blockade into platelets. OBJECTIVE: The authors propose that bleeding as a result of SSRI use may also be caused by other mechanisms. METHOD: Here, the authors report on a 32-year-old woman with hemorrhages resulting from severe drug-induced immune thrombocytopenia after 4 weeks of citalopram therapy. RESULTS: After withdrawal of citalopram and treatment with platelet concentrates and prednisolone, the patient recovered completely. CONCLUSION: As this case report shows, drug-induced immune thrombocytopenia may present another possible mechanism for bleeding in SSRI-treated patients.

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