Can I Use SSRIs for Anxiety with Immune Thrombocytopenia?

Use of SSRIs in Immune Thrombocytopenic Purpura (ITP)

Dear Dr.
Gao,
I have been diagnosed with immune thrombocytopenic purpura (ITP) for about 10 years, and my platelet count has been consistently between 10,000 and 20,000.
Currently, I am not receiving any treatment for my platelet levels.
My hematologist has indicated that since I am a chronic patient, if my platelet count remains above 10,000-15,000, I do not need to undergo treatment.
For the past five years, I have been struggling with anxiety and panic disorders, which I usually manage with sedatives during episodes.
Recently, due to work-related stress, my anxiety and panic symptoms have intensified.
My psychiatrist has recommended that I take an SSRI to increase serotonin levels, stabilize my mood, and manage my anxiety and panic without becoming overly reliant on sedatives, addressing the issue at its root.
I mentioned my ITP to him, and he believes that SSRIs may not significantly affect platelet levels and has suggested that I proceed with them.
However, I would like to ask you, Dr.
Gao, whether it is safe for someone with my platelet count, typically between 10,000 and 20,000, to use SSRIs.
I have read several articles stating that SSRIs can potentially lower coagulation function and increase the risk of bleeding.
I am hesitant to rely too much on sedatives and want to improve my serotonin levels to alleviate my anxiety.
Currently, SSRIs are the only medications that have shown good effects on my anxiety, so I am truly conflicted about whether to take them.
I am also concerned that taking them might affect my platelet count and lead to bleeding, which would only increase my anxiety and make it harder to decide.
I would greatly appreciate your professional opinion on this matter.
Thank you for taking the time to read my concerns.

Sam, 20~29 year old female. Ask Date: 2023/02/14

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
The impact of SSRIs on platelet function and coagulation is generally minimal.
However, caution is warranted for patients with ITP (Immune Thrombocytopenic Purpura).
I have a few suggestions:
1.
There have been significant advancements in the treatment of ITP, including the use of romiplostim.
Although this medication is not covered by insurance, it has shown good efficacy in increasing platelet counts.
If financially feasible, it may be worth considering.
An increase in platelet count can enhance the safety of medication use.
Therefore, I recommend discussing new treatment options with your hematologist.
2.
If your physician does not recommend romiplostim or if financial considerations prevent its use, it is important to discuss the safety of SSRIs with your doctor.
The risks associated with SSRIs should still be carefully considered for patients with low platelet counts.

Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2023/02/14

More Info

When considering the use of Selective Serotonin Reuptake Inhibitors (SSRIs) for anxiety in patients with Immune Thrombocytopenia (ITP), there are several important factors to take into account. ITP is a condition characterized by low platelet counts, which can increase the risk of bleeding. Your platelet levels, which range from 10,000 to 20,000, are indeed quite low, and this raises valid concerns about the potential effects of SSRIs on your condition.

SSRIs, such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil), are commonly prescribed for anxiety and depression. They work by increasing serotonin levels in the brain, which can help improve mood and reduce anxiety. However, there is some evidence suggesting that SSRIs may have an impact on platelet function and coagulation, potentially increasing the risk of bleeding, especially in patients with already low platelet counts.

Research has shown that SSRIs can affect platelet aggregation and may lead to a higher incidence of gastrointestinal bleeding, particularly when used in conjunction with other medications that affect bleeding, such as anticoagulants or non-steroidal anti-inflammatory drugs (NSAIDs). The risk of bleeding is particularly concerning in patients with ITP, where the underlying condition already predisposes them to bleeding complications.

Given your specific situation, where your platelet counts are consistently low, it is crucial to approach the decision to start SSRIs with caution. Here are some recommendations:
1. Consult Your Healthcare Provider: It is essential to have an open discussion with your healthcare provider, particularly your hematologist and psychiatrist. They can provide personalized advice based on your medical history, current health status, and the severity of your anxiety symptoms.

2. Monitor Platelet Counts: If you and your healthcare provider decide that starting an SSRI is appropriate, regular monitoring of your platelet counts will be necessary. This will help ensure that any potential changes in your platelet levels can be addressed promptly.

3. Consider Alternative Treatments: If the risks associated with SSRIs are deemed too high, you might explore alternative treatments for anxiety. Cognitive-behavioral therapy (CBT) is an effective non-pharmacological approach that can help manage anxiety without the risks associated with medication. Additionally, other classes of medications, such as certain anxiolytics or non-SSRI antidepressants, may be considered.

4. Evaluate the Benefits vs. Risks: The decision to use SSRIs should weigh the potential benefits of improved anxiety management against the risks of exacerbating bleeding tendencies. If your anxiety significantly impacts your quality of life and daily functioning, this may influence the decision to proceed with SSRIs.

5. Start with Caution: If SSRIs are initiated, starting at a low dose and gradually increasing it can help minimize side effects and allow for better monitoring of any adverse reactions.

In summary, while SSRIs can be effective for treating anxiety, their use in patients with ITP requires careful consideration and close monitoring. Collaboration between your healthcare providers will be key to finding a safe and effective treatment plan that addresses both your mental health needs and the risks associated with your low platelet counts. Always prioritize open communication with your healthcare team to ensure that you receive the best possible care tailored to your unique situation.

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