the Risks of SSRIs: A Guide for Patients with Liver Concerns

Q: the Risks of SSRIs: A Guide for Patients with Liver Concerns

Hello： I checked the research article mentioned in the news, and it studied individuals with a history of cerebral hemorrhage rather than generally healthy people. <br>The average age of the participants was around 71 years, which is quite different from your situation, so there

SSRI Issues

Hello, Doctor.
A few years ago, I sought treatment for anxiety and obsessive thinking issues.
Initially, I tried several medications, and after finding a suitable one, I have been taking Paroxetine HCl Hemihydrate 20mg as prescribed, one tablet at bedtime.
However, I often only take half a tablet when my condition is stable, and sometimes I forget to take it until I feel heavy-headed during the day, at which point I take another half tablet at night.
I have somewhat adopted a mindset of treating it like a supplemental vitamin for mental health.

Since I am a carrier of Hepatitis B, I am very cautious with medications.
Recently, due to a skin issue, I accidentally took a small amount of steroids (which are contraindicated for Hepatitis B carriers), prompting me to review my medications.
In my search, I came across a medical article that mentioned the following:
In recent years, there has been increasing research on the use of SSRIs for "promoting recovery of motor function after a stroke." However, the bleeding side effects of SSRIs have also gained attention and discussion among neurologists.
A study published this year in the well-known medical journal JAMA Neurology found that SSRIs significantly increase the risk of intracerebral hemorrhage, especially when used in conjunction with anticoagulants, which further elevates the risk.
The heightened risk is most pronounced during the first month of treatment.
Patients are advised that combining SSRIs with anticoagulants may increase the risk of hemorrhagic stroke.
I sometimes experience bruising, which I attribute to minor bumps, though I am not always certain of the cause (it doesn’t happen frequently).
My platelet counts have been normal during Hepatitis B monitoring.
However, I was alarmed to learn that SSRIs could increase the risk of hemorrhagic stroke (the recent news has been quite frightening).
I would like to ask how to correctly interpret the information from the medical journal mentioned, or if there are alternative medication recommendations (especially if I am just looking for something akin to a mental health vitamin).
Thank you, Doctor, for taking the time to respond.

yu, 40~49 year old female. Ask Date: 2022/04/07

Dr. Wang Yaoting reply Psychiatry

Hello: I checked the research article mentioned in the news, and it studied individuals with a history of cerebral hemorrhage rather than generally healthy people.
The average age of the participants was around 71 years, which is quite different from your situation, so there is no need to worry too much.
SSRIs can potentially increase the risk of bleeding, but this mostly occurs when they are used in conjunction with anticoagulants or non-steroidal anti-inflammatory drugs, and primarily involves gastrointestinal bleeding; reports of spontaneous intracerebral hemorrhage are quite rare.
Since you are taking only half a tablet, you should not be overly concerned.
If you continue to experience side effects from the medication, you can discuss it with your treating physician.
I hope this answers your question! :)

Reply Date: 2022/04/07

More Info

When considering the use of Selective Serotonin Reuptake Inhibitors (SSRIs) like Paroxetine (Paxil) for anxiety and obsessive-compulsive disorder, especially in the context of having a chronic liver condition such as being a hepatitis B carrier, it is essential to understand both the benefits and potential risks associated with these medications.

SSRIs are commonly prescribed for various mental health conditions due to their efficacy in increasing serotonin levels in the brain, which can help improve mood and reduce anxiety. However, as you have discovered, there are important considerations regarding their safety, particularly concerning bleeding risks and interactions with other medications.

Understanding the Risks of SSRIs
1. Bleeding Risks: Recent studies, including those published in reputable journals like JAMA Neurology, have indicated that SSRIs may increase the risk of bleeding, particularly intracranial hemorrhage, especially when used in conjunction with anticoagulants. This is particularly concerning for individuals who may already have a predisposition to bleeding or those who are on medications that affect blood clotting. The increased risk is most pronounced during the first month of treatment.

2. Liver Health Considerations: For patients with liver conditions, such as being a hepatitis B carrier, the metabolism of medications can be affected. SSRIs are primarily metabolized in the liver, and any impairment in liver function can lead to increased levels of the drug in the bloodstream, potentially heightening the risk of side effects. It is crucial to monitor liver function regularly and discuss any concerns with your healthcare provider.

3. Bruising and Bleeding: You mentioned experiencing occasional bruising, which can be a side effect of SSRIs. While some bruising can occur due to minor bumps, if you notice an increase in bruising or other bleeding symptoms, it is essential to consult your doctor. They may want to evaluate your platelet levels and overall blood coagulation status.

Interpreting Medical Literature
When interpreting medical studies or articles, it is vital to consider the following:
- Context of the Study: Understand the population studied, the methodology used, and whether the findings are applicable to your situation. For example, studies that focus on patients with specific comorbidities may not directly apply to those without those conditions.

- Consulting Healthcare Providers: Always discuss findings from medical literature with your healthcare provider. They can help contextualize the information based on your health history and current medications.

- Risk vs. Benefit Analysis: Weigh the potential risks of SSRIs against their benefits. If the medication significantly improves your quality of life and anxiety symptoms, it may be worth continuing under careful supervision.

Alternative Options
If you are concerned about the risks associated with SSRIs, especially if you are using them as a "mental vitamin," consider discussing alternative treatments with your healthcare provider. Some options may include:
- Psychotherapy: Cognitive Behavioral Therapy (CBT) and other forms of therapy can be effective for anxiety and may not carry the same risks as medications.

- Lifestyle Modifications: Regular exercise, a balanced diet, and mindfulness practices can also help manage anxiety symptoms.

- Natural Supplements: Some patients find relief with natural supplements such as omega-3 fatty acids, magnesium, or herbal remedies like St. John's Wort, though these should also be discussed with a healthcare provider to avoid interactions.

Conclusion
In summary, while SSRIs can be effective for treating anxiety and related disorders, their use in patients with liver concerns requires careful consideration of the risks, particularly regarding bleeding. Regular monitoring, open communication with your healthcare provider, and exploring alternative treatment options can help you manage your mental health safely and effectively. Always prioritize your health and safety by discussing any changes in your medication regimen or concerns about side effects with your doctor.

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