Ecchymoses as an adverse effect of fluoxetine treatment

Background

Abnormal bleeding has been reported with several antidepressants especially SSRIs. Only 25 cases have been reported in the literature, covering a spectrum from abnormal subclinical laboratory findings to ecchymoses and bleeding. Althought there are theories concerning the etiopathogenic mechanisms, data are inconclusive.

Material and Methods

We report a case of ecchymosis leading to treatment discontinuation following fluoxetine use. The case concerned a 28 years old female patient suffering from DSM-IV major depression.

Results

She was not receiving any medication during the previous 6 months. She was started on fluoxetine 20 mg daily and after three weeks the dose raise to 40 mg. After about a week and while the patient started responding to treatment, she manifested 7 ecchymoses in the inner surface of both thighs. All laboratory investigation including blood and biochemical testing, liver and renal function, prothrombin time, partial prothrombin time and bleeding time were normal. This was in accord with the literature. She was changed to sertraline (gradually up to 200 mg daily). Depressive symptoms resolved within the next four weeks. About one and a half month after fluoxetine discontinuation and still under sertraline treatment ecchymoses gradually disappeared. From the history of the patient, it is clear that there was a temporal relationship between ecchymoses and fluoxetine treatment.

Discussion

Although ecchymoses is a benign adverse effect of antidepressant therapy, it is important for the clinician to be alert, since its relationship to other life-threatening blood-related adverse effect is unknown