From: "Dr. D. Kossove" <doctordee@telkomsa.net>
To: "LMS List" <L-M-SARCOMA@LISTSERV.ACOR.ORG>; "mesothelioma list" <MESOTHELIOMA@listserv.acor.org>; "ACC List" <adrenocorticalcarcinoma@yahoogroups.com>; "Rare Cancer List" <RARE-CANCER@LISTSERV.ACOR.ORG>; "LiF List" <LI-FRAUMENI@LISTSERV.ACOR.ORG>
Subject: clotting and depression and SSRI antidepressants
Date: Wednesday, November 12, 2003 2:26 PM

The info below was from Medscape's CME, Psychiatry section,
"Psychiatry and Medicine  Common Patients Different Perspective"

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We found that clot formation, the conversion of prothrombin to
thrombin, was markedly hyperactive in depressed patients, both at
baseline and after orthostatic challenge, compared with normal
volunteers.

The take-home message is that depressed patients show multiple
abnormalities in the platelet clotting cascade, all directed towards a
greater likelihood of clot formation. What happens when you treat
these patients? In one study, these patients were treated either with
nortriptyline, paroxetine, or an SSRI. The investigators examined how
SSRI treatment normalizes -- or begins to normalize -- this abnormal
platelet function.

Patients treated with SSRIs frequently complain of being bruised, or
having bruises and not knowing why. That's because all SSRIs have
inherent antiplatelet activity. In another study, depressed patients
and a group of normal volunteers were treated with paroxetine -- the
first step in platelet activation. Depressed patients were clearly
abnormal in platelet function. After 6 weeks of paroxetine treatment,
platelet function returned to normal.

~~~~~

These patients were on a lot of medications for their heart disease --
91% were on aspirin, and 85% were on statins. More than three-quarters
were on beta blockers. Many were on antiplatelet drugs. In spite of
all their medications, these patients still had abnormal platelet
function. Depression is such a powerful factor in abnormal platelet
function that even if a patient is taking aspirin and antiplatelet
drugs, including warfarin, the depression force is powerful enough to
cause a clotting diathesis.


An epidemiological study published in 2001 in Circulation showed that
SSRI users have a lower rate of first-time MI compared to non-SSRI
users in the community. These results provide further evidence that
SSRIs are effective, not only in treating depression but also in
reducing cardiac disease and mortality.

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from
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Psychiatry and Medicine: Common Patients, Different Perspectives
Chairperson: Charles B. Nemeroff, MD, PhD; Faculty: Dominique L.
Musselman, MD; Steven E. Bruce, PhD; Philip T. Ninan, MD; Larry
Culpepper, MD, MPH


Copyright  2003 M2 Communnications.
This program is based on an Industry-Supported Symposium presented at
the American Psychiatric Association 156th Annual Meeting. The APA was
not involved in, and received no commercial support for, the
development of this product and does not award CME credit for this
program. This CME activity is based on transcripts and slides of
presentations as delivered by the faculty at the "Psychiatry and
Medicine: Common Patients, Different Perspectives" symposium held at
the Hilton San Francisco in San Francisco, California on May 18, 2003.

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