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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Chris Crosby on December 29, 2010, at 11:47:16
Hello,
I am new to this group.
I suffer from severe anxiety and moderate depression. Over the past 17 years I have tried over 50 medications without finding one(s) that truly helped.
I have told my doctor I will no longer try new medications unless I know how they will affect my platelet count. My platelets hover around 100,000, but have been as low as 80,000. I have seen a couple of hematologists and they both agree that the cause must be medication (when I stop medication my platelets went up).
I am currently taking 10mg Lexapro, 2 mg Klonopin, and 25 mg Trazadone. However I still suffer quite a bit from anxiety and depression.Effexor seemed to help me the most, but my platets went way down.
I realize I can survive ok with platelets at 100,000, but I do not want to play with my health in this way (particularly because my mother bled to death during surgery--her blood could not clot).
I appreciate any input.
Chris
Posted by Phillipa on December 29, 2010, at 13:13:33
In reply to low platelets, posted by Chris Crosby on December 29, 2010, at 11:47:16
Chris welcome to babble. This I've not heard of with psych meds. You are not on any blood thinners right? Any ideas from your regular medical doctor? I'm hoping someone has heard or has had a similar experience. Phillipa
Posted by Chris Crosby on December 29, 2010, at 13:36:01
In reply to Re: low platelets » Chris Crosby, posted by Phillipa on December 29, 2010, at 13:13:33
Phillipa--Thank you for the welcome.
No I am not on blood thinners. My regular doctor sent me to the hematologist. The hematologist thought that it is highly likely that it is my medication. Some of the medication I have taken, such as Effexor and Lyrica have affected my platelets more than other meds.
Chris
Posted by Phillipa on December 29, 2010, at 21:10:50
In reply to Re: low platelets, posted by Chris Crosby on December 29, 2010, at 13:36:01
Chris this is a definite google for me. Phillipa
Posted by Maxime on December 29, 2010, at 21:37:45
In reply to low platelets, posted by Chris Crosby on December 29, 2010, at 11:47:16
Here is a list of meds that can cause low platelets.
Antidepressants
Amitriptyline
Desipramine
Doxepin
Imipramine
MianserineSo you are safe on Lexapro. Was your doctor thinking of changing your antidepressant?
Posted by Maxime on December 29, 2010, at 21:40:51
In reply to low platelets, posted by Chris Crosby on December 29, 2010, at 11:47:16
Oh, low platelets are listed as a *RARE* side effect of Lexapro.
Posted by Brainbeard on December 30, 2010, at 16:37:35
In reply to low platelets, posted by Chris Crosby on December 29, 2010, at 11:47:16
.... and doctors are often hardly aware of it.
From http://www.ncbi.nlm.nih.gov/pmc/articles/PMC55923/:
'Serotonin potentiates platelet aggregation. Selective serotonin reuptake inhibitors decrease serotonin uptake from the blood by platelets. Because platelets do not synthesise serotonin, these inhibitors decrease the amount of serotonin in platelets. Case reports suggest that serotonin reuptake inhibitors are associated with a variety of bleeding events.'
The study of De Abajo is the landmark study for this link between SSRI's and bleeding: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC28262/
I have been reading up on this, and the amount of platelet inhibition is in proportion with the amount of serotonin reuptake inhibition. Lexapro is a strong SRI, which means it will inhibit platelet function. Not only (S)SRI's, but also 5HT2A-antagonists inhibit platelet function. This is my finding, which I have deduced from the fact that several 5HT2A-antagonists turned out to be associated with an unexpected risk of bleeding plus the fact that 5HT2A receptors play a key role in platelet aggregation.
(S)SRI's by themselves pose only a low risk for gastrointestinal or other types of serious bleeding, but the risk increases dramatically when (S)SRI's are combined with NSAID's (like Ibuprofen). If I need to take an NSAID (in case of severe toothache, for instance), I will take a stomach protector (omeprazole, proton pump inhibitor) with it - but I had to ask for these myself, my doctor wasn't aware of the risk.
I have an anxiety disorder, and the increased risk of gastrointestinal bleeding on S(S)RI's kept me back from taking therapeutic doses for a long time. I accept the risk now, realizing that my neurotic anxiety magnifies the (impact of the) risk by a factor thousand.
See also:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884264/
Posted by Jasper900 on January 2, 2011, at 13:52:20
In reply to low platelets, posted by Chris Crosby on December 29, 2010, at 11:47:16
Hi Chris Crosby,
I understand your concern about low platelets. I was born with Immune thrombocytopenic purpura (ITP). My platelet count hovers between 10,000 and 20,000. From all the specialists I have seen over the years they have never been worried unless it dips below 15,000. A couple of times my count dropped below 10,000 and I got treatment to bring it back up and the treatment brings them wayy up to 300,000 for about a month and then it plumits back down to about 15,000. I have not had any treatment for 13 years and my platelets have remained between 10,000 and 20,000.
I have been on all the SSRI's, 2 Maoi's, AP's, tranquilizers, Trazodone.. I cant remember them all But the point I'm trying to make is that if your platelets remain above 50,000 there is nothing to worry about, only when they drop below 20,000 should you be concerned.
PS. none of the meds made a substancial change in my platelet count. There are soo many other processes involved with clotting, so as long as you stay above 20,000 and dont have any other clotting problems you will be just fine.
And the rule of thumb is: if your count stays above 50,000 there is nothing to worry about, if it falls below 50,000 it should be monitored, if your count drops below 20,000 maybe get treatment, if it drops below 10,000 then that's the danger zone. But anything above 50,000 is considered safe.
Posted by Chris Crosby on January 2, 2011, at 15:06:07
In reply to Re: low platelets, posted by Jasper900 on January 2, 2011, at 13:52:20
I really appreciate all the feedback. It helps me fell that I'm not alone with my concerns and problems.
Thank you--Chris
Posted by Phillipa on January 2, 2011, at 19:43:22
In reply to Re: low platelets, posted by Jasper900 on January 2, 2011, at 13:52:20
I didn't know there was an immune one. I guess vit K would play a role also and liver function tests. Since clotting takes place in liver with the K. Phillipa
This is the end of the thread.
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