Kaye Alan D, Cooper Harrison D, Mashaw Sydney A, Anwar Ahmed I, Hollander Alex V, Thomassen Austin S, Singh Anushka, Shekoohi Sahar
Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA.
School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA.
Curr Pain Headache Rep. 2025 Jun 25;29(1):97. doi: 10.1007/s11916-025-01412-0.
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.
抗抑郁药，尤其是选择性5-羟色胺再摄取抑制剂（SSRIs）和5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs），被广泛用于治疗精神疾病。然而，这些药物与因抑制5-羟色胺再摄取而增加的出血风险有关，这会损害血小板聚集。本研究探讨了抗抑郁药的药效学、出血并发症的临床证据以及管理这些风险的策略。
虽然SSRIs和SNRIs的出血风险最高，但三环类和非典型抗抑郁药的出血发生率相对较低。同时使用抗凝剂、非甾体抗炎药或抗血小板药物会显著增加出血风险。当前指南强调个体化风险评估、选择替代药物以及采取预防措施，如使用胃保护剂。未来的研究可能会提供新的方法来减轻出血风险，同时保持治疗效果，确保抗抑郁药在临床实践中的安全性。
