vWD,ssri,snri and GI bleeding

General
1

I have had 2 major nosebleeds (one pint loss), a major gum bleed after dental cleaning, three major upper GI bleeds from AVMs which resulted in anemia (Hgb near 8 g/dL) in the last three years. The GI bleeds were in the last four months. I was taking cymbalta and then switched to Viibryd.... poor choice!

It turns out that ssri and snri anti-depressants bind to plasma proteins which include some of the blood coagulation factors. That appears to be pouring gas on a fire as the bound proteins like factor 8 are not likely to function appropriately in coagulation. vWF protein depends on binding to itself to make multimers in order to function in coagulation. If the binding sites are occupied by anti-depressant molecules then the multimers probably won't form.So.... empirically speaking, my bleeding history is a side-effect of treating depression. Did someone say between a rock and a hard place?

John the elder

Anybody have a similar history????

2

thanks for sharing!

3

John,

This is what I have learned (the hard way!) Don't take any medication or herb or oil unless you've researched the precautions and possibility that it may increase risk of bleeding, period. Even the best hematologists are not going to research each and every thing that you might want to take. Do it yourself. Save yourself alot of grief and you could die in the meantime from something very simple.

Cymbalta carries risk for bleeding, not familiar with Viibryd. I have a brain Cavernoma that bled. I've bled from vitamin E, primrose oil, fish oils, bromalain, nettle, topical anti inflamatory gel, ibuprofen, nsaids, toradol and more. Doctors say "oh it's just a little bit, it won't bother you" Wrong!!! I live between a rock and a hard place. Nothing I can do about that.

Like I told my one doctor the other day, when he wanted me to take flax oil, "what do you want me to do? I can't get born over again!!" I have von willebrands and I bleed from the stuff." Then he admitted that he didn't understand von willebrands.

I got tired of jumping through hoops for doctors who insist that I take something that makes me bleed. They don't understand Von Willebrands.

Have you tried to check for vitamin dificiencies. Some can cause depression, such as Vit D. There is one lab panel that Medicare pays for that's done by "Spectracell Laboratories". Also, hormonal changes in men can cause depression.

http://www.spectracell.com/micronutrient-testing-comprehensive-nutritional-panel/

contact the lab and ask is your insurance pays for the test.....

http://www.spectracell.com/contact-us/

This is just a suggestion. I know what it's like to be limited in what you can take. But I have gotten off all medication, except my thyroid med, and I'm better off for it. Remember, the anti-depressants only mask the symtoms of depression, they don't get to the source of the problem.

Good luck to you John. BTW, I took your advice about getting a standing order for the ddavp, and now I have one in my purse and carry it with me. Thanks, good advice.

Take care,

Allergic

4

Tnx to all for taking the time to reply. My family has significant history of depressive illness. Two of our four children have died from depression related causes. Six out of ten nephews and nieces have problems. So there seems to be a definite neuro-chemical problem. It turns out that SSRI meds interfere directly with making plasma seretonin available to blood platelets which initiate coagulation. So there is a direct cause and effect listed in the literature. I will look into the diet issues with vitamin balance. We do garden and eat a traditional balanced diet.

As to Doctors, hematologists don't talk to enterologists who don't talk to cardiologists, so I made it my mission to bring references for the interdisciplinary issues like aortic stenosis, vWD, GI bleeds and drug interactions. with me to the offices. Dr. Google is very informative once you get past all the medical jargon by using Wikepedia.

John the elder

5

First of all, ddavp is NOT for clotting issues. Stimate is. They are not the same thing. My hemo doc tried giving me that crap and I told him no. My kids’ hemo doc told me to refuse it if the pharmacy tried to give it to me. They are 2 different strengths for treating 2 different kinds of issues.
Secondly, does anybody know if Abilify affects either VW factor and/or Factor 8? My oldest is on it and she’s already too low on both.

6

Here is a link that explains despopressen/ddavp/stimate. Read under Mode of Action and Coagulation Disorders. They are all the same, just different forms and strengths, and different brand names. The prescribing doctor should be aware of this. Stimate is not as strong. In some situations(like surgery), ddavp, which IS desmopressin, just like stimate,ordered to be given prior to surgery. They are all for clotting issues.

http://en.wikipedia.org/wiki/Desmopressin

http://www.childrensmn.org/manuals/pfs/med/018912.pdf

7

My doctor always tells me to check with him before I try any new medicine. About two months ago, I took fenugreek and it raised my INR to a dangerous level. When I told him what I was taking, he looked it up on a college medical website (I forget the name, but i'm going to ask him next week when I see him). I've also found this website for herbal remedies (http://www.nutriherb.net/herbs.html) . Some are safe for us and some aren't. I think you may have to play around with some medicines until you find what works for you. Everyone tskes to medicine differently. Hope this helps a little bit :)

8

Hia John and YES - I was on Venlafaxine for 8 years(an SNRI) and had a TERRIBLE time with bleeding problems, extra spontaneous joint bleeds, massive nosebleeds(slept through a couple and went into hypovolaemic shock) similarly with menstruation ramped up to an 8 month period that culminated in an 18 pint a day loss, obviously I am a type 3 but all these major events happened whilst on anti-depressants. I have less of a reaction to amitriptyline although I have been having a steady Hb/GI loss since being on it(still awaiting pill-cam results to see if there's an AVM/angiodysplasia).(I also had a hideous time when I once took a High Strength Cod Liver oil supplement-woke up next day with 2 joint bleeds, nosebleed, mouth bleed, GI bleed and period) Hmm. What to do!?

Helen type 3

9

Like you John we have significant family history of mental illness.

Johntheelder said:

Tnx to all for taking the time to reply. My family has significant history of depressive illness. Two of our four children have died from depression related causes. Six out of ten nephews and nieces have problems. So there seems to be a definite neuro-chemical problem. It turns out that SSRI meds interfere directly with making plasma seretonin available to blood platelets which initiate coagulation. So there is a direct cause and effect listed in the literature. I will look into the diet issues with vitamin balance. We do garden and eat a traditional balanced diet.

As to Doctors, hematologists don't talk to enterologists who don't talk to cardiologists, so I made it my mission to bring references for the interdisciplinary issues like aortic stenosis, vWD, GI bleeds and drug interactions. with me to the offices. Dr. Google is very informative once you get past all the medical jargon by using Wikepedia.

John the elder

10

Thanks to all for! responding again. And I just found out that my youngest sister is near death from stage four cancer and perforated bowel from that cause. When it rains it pours. The medical examiner just told me, ten minutes ago, my oldest son's cause of death was acute alcoholism, which we knew about but he wouldn't except change or intervention. So taking the serotonin reuptake inhibitors and SNRI like venlafaxine are associated with increased bleeding just as we suspected. Too bad the manufacturers are touting less heart attacks because your blood won't clot therefore take more and more!

I am sorry to hear about the type 3, Nellie. My pill-cam is being scheduled. The AVM/angiodysplasia in the small bowel hopefully will not be extensive. I am trying to be cheerful but the damn anemia is a constant struggle. Not taking any depression medicine now but my bucket list precludes being a couch potato til I check out! I guess we have to keep cheering each other up! I will pass your note to my Hematologist.Then I will go look at some of my flower gardens and try to be extra nice to my wife.

John the elder

11

http://www.medscape.org/viewarticle/577463 SSRIs and Venlafaxine Linked to Greater Risk for Gastrointestinal Tract Bleeding

12


John - I am so very sorry to hear your news - what a truly horrible time you are going through ((hugs)).

If you would like to email me I can pass on a couple of papers on vWd and GI loss/angio-dysplasia that my Consultant Mike Makris has written. I can be contacted on helencampbell6@aol.co.uk - anyone else interested I am happy to pass them on to you too - just message me. I am at an absolute loss as to what to do re: treatment for depression and vWd although I definitely have less bleeding issues overall on the old Tricyclic anti-depressants (amitriptyline) except for this suspected GI loss(which doesn't sound as severe as yours as I'm hovering between 9.1 and 10.6 with my Hb). I have also been told in no uncertain terms that it's also 'a disease of the aging gut' - I wouldn't mind so much but this started last year when I was 39 lol! My Psychiatrist basically said anything that has a serotegenic effect will have knock-on bleeding issues for me. I did 8 years on Venlafaxine for severe depression and actually found that to be the worst, I was allergic to Fluoxetine(developed hives and blacked out), I became suicidal on Sertraline, and Mirtazapine and Citalopram had me bleeding within a couple of hours of the first dose, so I packed it in. Helen xx

Oh and did you know that caffeine makes bleeding worse? I'd been telling my Dr that since I was about 7 (if I had more than 3 cups of caffeinated tea/coffee a day my nosebleeds got much worse) and it's also been recently proven.


Johntheelder said:

Thanks to all for! responding again. And I just found out that my youngest sister is near death from stage four cancer and perforated bowel from that cause. When it rains it pours. The medical examiner just told me, ten minutes ago, my oldest son's cause of death was acute alcoholism, which we knew about but he wouldn't except change or intervention. So taking the serotonin reuptake inhibitors and SNRI like venlafaxine are associated with increased bleeding just as we suspected. Too bad the manufacturers are touting less heart attacks because your blood won't clot therefore take more and more!

I am sorry to hear about the type 3, Nellie. My pill-cam is being scheduled. The AVM/angiodysplasia in the small bowel hopefully will not be extensive. I am trying to be cheerful but the damn anemia is a constant struggle. Not taking any depression medicine now but my bucket list precludes being a couch potato til I check out! I guess we have to keep cheering each other up! I will pass your note to my Hematologist.Then I will go look at some of my flower gardens and try to be extra nice to my wife.

John the elder

13

Sorry just have to correct you hear Erin, Stimate is actually desmopressin as is DDAVP, Stimate is the brand name of the nasal spray of the desmopressin and DDAVP is the IV(usually) version of desmopressin, used to treat von Willebrands(type 1 mainly), there is a weaker form of desmopressin available to treat enuresis(bed-wetting in children). that's probably how the confusion has arisen.

I've not heard of any reports from vWd sufferers who take anti-psychotics and their effect on blood clotting(mind you there are only 2 of us that I know!). Have you noticed any difference in bleeding since your eldest has been on it?

x

erin hurley said:

First of all, ddavp is NOT for clotting issues. Stimate is. They are not the same thing. My hemo doc tried giving me that crap and I told him no. My kids' hemo doc told me to refuse it if the pharmacy tried to give it to me. They are 2 different strengths for treating 2 different kinds of issues.
Secondly, does anybody know if Abilify affects either VW factor and/or Factor 8? My oldest is on it and she's already too low on both.