Paroxetine is a selective serotonin reuptake inhibitor (SSRI), and an effective long-term treatment for social anxiety and major depression. SSRIs in general, and paroxetine in particular, were described as associated with depletion of serotonin in platelets. Serotonin is involved in platelet aggregation, and the association of bleeding and SSRI use was suggested two decades ago. In the last few years, some reviews have confirmed that initial fear. In contrast with aspirin, SSRIs seem to be related to non-ulcer, non-variceal gastrointestinal bleeds. SSRIs are usually associated with upper gastrointestinal bleeding but there is surprisingly little literature on lower gastrointestinal bleeding (LGIB) associated with SSRI use. The annual incidence of LGIB is approximately 20–30 cases per 100,000 inhabitants in Western countries; the incidence increases with age. We present two young males with no medical problems besides their psychiatric diagnoses presenting with LGIB after paroxetine use.

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Published in Psychosomatics, v. 53, issue 2, p. 184-187.

Copyright © 2012 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

This manuscript version is made available under the CC-BY-NC-ND 4.0 license.

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Hilario Blasco-Fontecilla acknowledges the Spanish Ministry of Health (Rio HortegaCM08/00170), Alicia Koplowitz Foundation, and Conchita Rabago Foundation for funding his post-doctoral stage at CHRU, Montpellier, France.