A case of paroxetine-induced lower gastrointestinal bleeding: A multifaceted approach to healing

A case of paroxetine-induced lower gastrointestinal bleeding: A multifaceted approach to healing | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report A case of paroxetine-induced lower gastrointestinal bleeding: A multifaceted approach to healing Bushra Hamed Al Jasassi, Mohammed Abdullah Al Shuhoumi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4314191/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Selective serotonin reuptake inhibitors (SSRIs) are a mainstay treatment for panic disorder, however a potential link to lower gastrointestinal bleeding (LGIB), particularly with Paroxetine, is unknown. We present a rare case of LGIB possibly caused by Paroxetine in a 35-year-old female with panic disorder. LGIB resolved after SSRI cessation, implying a possible causative relationship. We conducted a thorough clinical evaluation, including medical history, medication review, and endoscopic investigations. The patient complained of hematochezia, dizziness, and shortness of breath, which coincided with the start of Paroxetine for panic disorder. A colonoscopy indicated non-specific colitis, while an upper GI endoscopy revealed no abnormalities. LGIB resolved within a week of discontinuing Paroxetine, with no recurrence during following follow-up. This example adds to the little evidence pointing to a possible link between Paroxetine and LGIB in panic disorder. More research is required to understand the underlying mechanisms and confirm causality. While initially mysterious, this case eventually revealed the complicated connection between mental health, medicine, and physical manifestations. It emphasized the significance of alertness in monitoring potential side effects, the efficacy of alternative therapies such as CBT, and the importance of patient awareness in managing complex medical problems. Psychiatry SSRIs lower gastrointestinal bleeding panic disorder Figures Figure 1 Figure 2 Introduction Panic disorder, which is defined by recurring and unexpected panic attacks, has a considerable negative influence on quality of life. 1 Selective serotonin reuptake inhibitors (SSRIs) have become standard treatment, providing significant alleviation. 2 However, a potential adverse effect, an increased risk of gastrointestinal (GI) bleeding 3 , puts a shadow on their success. While upper GI bleeding with SSRIs has received a lot of attention, lower GI bleeding (LGIB) is still relatively unknown, especially in the setting of panic disorder and specific SSRIs like Paroxetine. This case study digs into this uncharted terrain, giving light on the probable link between Paroxetine and LGIB in a panic disorder patient. Recent research reveals that SSRIs cause a small but concerning increase in GI bleeding. Research indicated that SSRI users had 3.6 times higher than expected increased risk of serious bleeding, especially GI bleeding. 4 Furthermore, research found a dose-dependent increase in the risk of upper GI hemorrhage, emphasizing the importance of careful dosing and monitoring. 5 Despite this known association, LGIB as a specific side effect of SSRIs has received little attention. Two case studies showed LGIB while using SSRIs, implying a possible link beyond upper GI bleeding. 6 However, due to a dearth of data and controlled trials, clear results are elusive. Panic disorder can manifest with GI symptoms, further complicating matters. In such circumstances, disentangling the contribution of SSRIs from the underlying mental health issue becomes critical. This case report attempts to add to existing knowledge by providing a rare incidence of LGIB likely related with Paroxetine in a panic disorder patient. We intend to shed light on this under-explored area and inform future research in this subject by rigorously studying the clinical presentation, medication history, and risk factors. Case Report A 37-year-old housewife with panic disorder who had been stable on Paroxetine for 4 months presented with a sudden and frightening incident of lower gastrointestinal bleeding. This horrifying occurrence was highlighted by fresh blood and big clots, in stark contrast to her prior improvement. Her panic attacks had disappeared prior to this incident, replaced by peaceful days and restful nights. Investigations at the emergency department found a reduction in hemoglobin, indicating internal bleeding. Nonetheless, regular testing such as coagulation profiles and platelet counts remained within normal limits. The baffling lack of an obvious perpetrator heightened the worry. An active bleeding ulcer around 10 cm from the anal margin was ultimately detected by a combined digital rectal examination and rigid proctoscopy. Rapid action was taken. Blood transfusions were given, and the gastrointestinal team rushed to get her ready for sigmoidoscopy and maybe colonoscopy. However, the initial technique produced only limited results. Clotted blood concealed the colon, making a definitive diagnosis impossible. With hemoglobin levels dropping even further, the medical team decided to perform a second look colonoscopy and an abdominal CT scan. This time, the second look colonoscopy revealed the true problem - a big, deep rectal ulcer. Figure A. Combined Digital rectal examination (DRE) with rigid proctoscopy revealed a source of active bleeding about 10 cm from anal verge during SSRIs administration. But the story wasn't only about the physical condition. When the clinical pharmacist noticed the unusual bleeding, he suspected that Paroxetine was a problem. This prompted an important decision: to cease the medicine and implement alternate management measures. Cognitive Behavioral Therapy (CBT) stepped in, replacing drug reliance with an emphasis on self-management skills. The patient's mood improved throughout the course of three appointments. Energy levels increased, tranquility returned, and, most crucially, she became conscious of her former reliance on drugs. Not only had the rectal bleeding ceased at the end of the month, but the patient's hemoglobin levels had returned to normal. A third sigmoidoscopy confirmed that the ulcer had healed completely. Figure B. Combined Digital rectal examination (DRE) with rigid proctoscopy revealed a source of active bleeding about 10 cm from anal verge when SSRIs administration was terminated. Discussion This case study emphasizes the possibility of atypical side effects related with Paroxetine treatment, even in seemingly stable patients. While upper gastrointestinal bleeding is more typically associated with SSRIs 7 , our case highlights the likelihood of lower gastrointestinal (LGIB) problems as well. The absence of recognizable coagulopathies or pre-existing gastrointestinal pathology adds weight to the drug-induced etiology concept. This is consistent with previous research indicating a relationship between SSRI usage and platelet serotonin depletion, which is required for platelet aggregation and hemostasis. 8 The quick withdrawal of Paroxetine and the implementation of alternate management techniques, including CBT, were critical in attaining symptom resolution as well as psychological empowerment. This is consistent with suggestions to prioritize non-pharmacological therapies in cases of mild to moderate anxiety. 9 However, more study is needed to determine the exact mechanisms behind SSRI-associated LGIB and to identify risk factors for such events. Larger cohort studies and meta-analyses could shed light on the prevalence and specific manifestations of this possible negative influence. Furthermore, in circumstances where SSRIs are deemed required, investigating alternate serotonergic drugs with fewer gastrointestinal bleeding risks may be advantageous. Escitalopram, citalopram, and fluoxetine are potential alternatives because they have been shown to reduce the risk of upper gastrointestinal problems. 10 Conclusion To conclude, this instance emphasizes the necessity of being on the lookout for unusual side effects related with Paroxetine, notably LGIB. Prompt recognition and withdrawal of the medicine, together with other therapeutic approaches, can result in good physical and psychological consequences. More research is needed to better understand the underlying mechanisms and risk factors related with this uncommon but potentially life-threatening condition. Declarations The patient has consented for both participation in the study and publication. Authors’ Contribution Bushra Hamed Al Jassasi managed the case in collaboration with Mohammed Abdullah Al Shuhoumi. Bushra Hamed Al Jassasi collected the data and drafted the manuscript. Mohammed Abdullah Al Shuhoumi revised and edited the manuscript. All authors approved the final version of the manuscript. Minimal part of the work was presented in an international conference (MDSC https://mdsc.website/ ) and part of the abstract was published as conference proceedings [11]. Conflict of interest The authors declare no conflict of interest. Funding No funding was received for this study. Ethics Patient was consented, and an official consent paper was granted that is available to be submitted to the editor in chief upon demand. References Bandelow B, Domschke K, Baldwin D. Panic disorder and agoraphobia. OUP Oxford ; 2013 Nov 21. WOODRUFF-BORDEN JA, LEE A, GRAMSZLO C. DESCRIPTION OF THE DISORDERS PANIC DISORDER. Adult Psychopathology and Diagnosis . 2018 Apr 3:299. Quinn GR, Hellkamp AS, Hankey GJ, Becker RC, Berkowitz SD, Breithardt G, Fava M, Fox KA, Halperin JL, Mahaffey KW, Nessel CC. Selective serotonin reuptake inhibitors and bleeding risk in anticoagulated patients with atrial fibrillation: an analysis from the ROCKET AF trial. Journal of the American Heart Association . 2018 Aug 7;7(15):e008755. Dalton SO, Johansen C, Mellemkjær L, Sørensen HT, Nørgård B, Olsen JH. Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal tract bleeding: a population-based cohort study. Archives of internal medicine . 2003 Jan 13;163(1):59-64. Shahrbabki ME, Shahrbabaki AE. Sertraline-related bleeding tendency: could it be dose-dependent?. Iranian Journal of Psychiatry and Behavioral Sciences . 2014;8(3):81. Blasco-Fontecilla H, de Leon J. Lower gastrointestinal bleeding and paroxetine use: two case reports. Psychosomatics . 2012 Mar 1;53(2):184. Meuret AE, Tunnell N, Roque A. Anxiety disorders and medical comorbidity: treatment implications. Anxiety disorders : Rethinking and understanding recent discoveries. 2020:237-61. Dietrich-Muszalska A, Wachowicz B. Platelet haemostatic function in psychiatric disorders: Effects of antidepressants and antipsychotic drugs. The World Journal of Biological Psychiatry. 2017 Nov 17;18(8):564-74. Reddy YJ, Sudhir PM, Manjula M, Arumugham SS, Narayanaswamy JC. Clinical practice guidelines for cognitive-behavioral therapies in anxiety disorders and obsessive-compulsive and related disorders. Indian journal of psychiatry . 2020 Jan;62(Suppl 2):S230. Jakobsen JC, Katakam KK, Schou A, Hellmuth SG, Stallknecht SE, Leth-Møller K, Iversen M, Banke MB, Petersen IJ, Klingenberg SL, Krogh J. Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. BMC psychiatry . 2017 Dec;17(1):1-28. 2nd Multidisciplinary Scientific Conference: Ibri Regional Hospital, Ibri, Oman, 31 December 2022. (2023). Sultan Qaboos University medical journal , 23(2), 276–283. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4314191","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":294714311,"identity":"b8b74530-e9f9-4c71-9e91-165ebd70199e","order_by":0,"name":"Bushra Hamed Al Jasassi","email":"","orcid":"","institution":"Ibri Regional Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bushra","middleName":"Hamed Al","lastName":"Jasassi","suffix":""},{"id":294714312,"identity":"07a88121-d607-403b-af0a-179c2e2ad10b","order_by":1,"name":"Mohammed Abdullah Al Shuhoumi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIie3PsQrCMBCA4YNCu5y4RhCf4TRQFQVfxalTCj6AiJOjs4/h5Fwo6lLomk0k4OAkCE4iXlAc27oJ5h8CgXzcBcDl+sFIB0dzJ0ACL+G7aJaSvkZJOLHEH1uCpWSk0Rd44XFWceUktEQQNLv17HrW0x5CkG7XxSQwPeIR/VW8GagdL4ZRpIsJtPXYbqVrG6l4Sf5OWEhIA4nEkjw7SfWoRjqNuSWJ8ky8qERQSh7Ei0WhFy8F+mV/ocP+aOA+HFGemqu6zVr1IN0VknfCHv7rrPD8k3f55rXL5XL9T09hnUR3RtyzGQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-6902-5391","institution":"Ibri Regional Hospital","correspondingAuthor":true,"prefix":"","firstName":"Mohammed","middleName":"Abdullah Al","lastName":"Shuhoumi","suffix":""}],"badges":[],"createdAt":"2024-04-23 20:20:46","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":true,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":true,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":true},"doi":"10.21203/rs.3.rs-4314191/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4314191/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55508843,"identity":"1895de04-a430-4e7d-85ec-af9e58219c60","added_by":"auto","created_at":"2024-04-29 12:17:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":363161,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure A. \u003c/strong\u003eCombined Digital rectal examination (DRE) with rigid proctoscopy revealed a source of active bleeding about 10 cm from anal verge during SSRIs administration.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4314191/v1/bfde8612cf1aa1c3d7dd6bf0.png"},{"id":55508844,"identity":"f9d34edc-d445-45de-a3de-68696aac4666","added_by":"auto","created_at":"2024-04-29 12:17:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":366810,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure B. \u003c/strong\u003eCombined Digital rectal examination (DRE) with rigid proctoscopy revealed a source of active bleeding about 10 cm from anal verge when SSRIs administration was terminated.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4314191/v1/c395f49fb5524353fde73ea6.png"},{"id":55508852,"identity":"1fe5c339-ea4d-4d28-865f-649b2b96a404","added_by":"auto","created_at":"2024-04-29 12:17:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1126615,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4314191/v1/91c037ac-780b-482c-9897-35065eb5190e.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eA case of paroxetine-induced lower gastrointestinal bleeding: A multifaceted approach to healing\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePanic disorder, which is defined by recurring and unexpected panic attacks, has a considerable negative influence on quality of life.\u003csup\u003e1\u003c/sup\u003e Selective serotonin reuptake inhibitors (SSRIs) have become standard treatment, providing significant alleviation.\u003csup\u003e2\u003c/sup\u003e However, a potential adverse effect, an increased risk of gastrointestinal (GI) bleeding \u003csup\u003e3\u003c/sup\u003e, puts a shadow on their success. While upper GI bleeding with SSRIs has received a lot of attention, lower GI bleeding (LGIB) is still relatively unknown, especially in the setting of panic disorder and specific SSRIs like Paroxetine. This case study digs into this uncharted terrain, giving light on the probable link between Paroxetine and LGIB in a panic disorder patient.\u003c/p\u003e \u003cp\u003eRecent research reveals that SSRIs cause a small but concerning increase in GI bleeding. Research indicated that SSRI users had 3.6 times higher than expected increased risk of serious bleeding, especially GI bleeding.\u003csup\u003e4\u003c/sup\u003e Furthermore, research found a dose-dependent increase in the risk of upper GI hemorrhage, emphasizing the importance of careful dosing and monitoring.\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDespite this known association, LGIB as a specific side effect of SSRIs has received little attention. Two case studies showed LGIB while using SSRIs, implying a possible link beyond upper GI bleeding.\u003csup\u003e6\u003c/sup\u003e However, due to a dearth of data and controlled trials, clear results are elusive. Panic disorder can manifest with GI symptoms, further complicating matters. In such circumstances, disentangling the contribution of SSRIs from the underlying mental health issue becomes critical.\u003c/p\u003e \u003cp\u003eThis case report attempts to add to existing knowledge by providing a rare incidence of LGIB likely related with Paroxetine in a panic disorder patient. We intend to shed light on this under-explored area and inform future research in this subject by rigorously studying the clinical presentation, medication history, and risk factors.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA 37-year-old housewife with panic disorder who had been stable on Paroxetine for 4 months presented with a sudden and frightening incident of lower gastrointestinal bleeding. This horrifying occurrence was highlighted by fresh blood and big clots, in stark contrast to her prior improvement. Her panic attacks had disappeared prior to this incident, replaced by peaceful days and restful nights.\u003c/p\u003e \u003cp\u003eInvestigations at the emergency department found a reduction in hemoglobin, indicating internal bleeding. Nonetheless, regular testing such as coagulation profiles and platelet counts remained within normal limits. The baffling lack of an obvious perpetrator heightened the worry.\u003c/p\u003e \u003cp\u003eAn active bleeding ulcer around 10 cm from the anal margin was ultimately detected by a combined digital rectal examination and rigid proctoscopy. Rapid action was taken. Blood transfusions were given, and the gastrointestinal team rushed to get her ready for sigmoidoscopy and maybe colonoscopy. However, the initial technique produced only limited results. Clotted blood concealed the colon, making a definitive diagnosis impossible. With hemoglobin levels dropping even further, the medical team decided to perform a second look colonoscopy and an abdominal CT scan. This time, the second look colonoscopy revealed the true problem - a big, deep rectal ulcer.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure A.\u003c/b\u003e Combined Digital rectal examination (DRE) with rigid proctoscopy revealed a source of active bleeding about 10 cm from anal verge during SSRIs administration.\u003c/p\u003e \u003cp\u003eBut the story wasn't only about the physical condition. When the clinical pharmacist noticed the unusual bleeding, he suspected that Paroxetine was a problem. This prompted an important decision: to cease the medicine and implement alternate management measures.\u003c/p\u003e \u003cp\u003eCognitive Behavioral Therapy (CBT) stepped in, replacing drug reliance with an emphasis on self-management skills. The patient's mood improved throughout the course of three appointments. Energy levels increased, tranquility returned, and, most crucially, she became conscious of her former reliance on drugs. Not only had the rectal bleeding ceased at the end of the month, but the patient's hemoglobin levels had returned to normal. A third sigmoidoscopy confirmed that the ulcer had healed completely.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure B.\u003c/b\u003e Combined Digital rectal examination (DRE) with rigid proctoscopy revealed a source of active bleeding about 10 cm from anal verge when SSRIs administration was terminated.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis case study emphasizes the possibility of atypical side effects related with Paroxetine treatment, even in seemingly stable patients. While upper gastrointestinal bleeding is more typically associated with SSRIs \u003csup\u003e7\u003c/sup\u003e, our case highlights the likelihood of lower gastrointestinal (LGIB) problems as well.\u003c/p\u003e \u003cp\u003eThe absence of recognizable coagulopathies or pre-existing gastrointestinal pathology adds weight to the drug-induced etiology concept. This is consistent with previous research indicating a relationship between SSRI usage and platelet serotonin depletion, which is required for platelet aggregation and hemostasis.\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe quick withdrawal of Paroxetine and the implementation of alternate management techniques, including CBT, were critical in attaining symptom resolution as well as psychological empowerment. This is consistent with suggestions to prioritize non-pharmacological therapies in cases of mild to moderate anxiety.\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHowever, more study is needed to determine the exact mechanisms behind SSRI-associated LGIB and to identify risk factors for such events. Larger cohort studies and meta-analyses could shed light on the prevalence and specific manifestations of this possible negative influence.\u003c/p\u003e \u003cp\u003eFurthermore, in circumstances where SSRIs are deemed required, investigating alternate serotonergic drugs with fewer gastrointestinal bleeding risks may be advantageous. Escitalopram, citalopram, and fluoxetine are potential alternatives because they have been shown to reduce the risk of upper gastrointestinal problems.\u003csup\u003e10\u003c/sup\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTo conclude, this instance emphasizes the necessity of being on the lookout for unusual side effects related with Paroxetine, notably LGIB. Prompt recognition and withdrawal of the medicine, together with other therapeutic approaches, can result in good physical and psychological consequences. More research is needed to better understand the underlying mechanisms and risk factors related with this uncommon but potentially life-threatening condition.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe patient has consented for both participation in the study and publication.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBushra Hamed Al Jassasi managed the case in collaboration with Mohammed Abdullah Al Shuhoumi. Bushra Hamed Al Jassasi collected the data and drafted the manuscript. Mohammed Abdullah Al Shuhoumi revised and edited the manuscript. All authors approved the final version of the manuscript. Minimal part of the work was presented in an international conference (MDSC https://mdsc.website/ ) and part of the abstract was published as conference proceedings [11].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient was consented, and an official consent paper was granted that is available to be submitted to the editor in chief upon demand.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBandelow B, Domschke K, Baldwin D. Panic disorder and agoraphobia. \u003cem\u003eOUP Oxford\u003c/em\u003e; 2013 Nov 21.\u003c/li\u003e\n \u003cli\u003eWOODRUFF-BORDEN JA, LEE A, GRAMSZLO C. DESCRIPTION OF THE DISORDERS PANIC DISORDER. \u003cem\u003eAdult Psychopathology and Diagnosis\u003c/em\u003e. 2018 Apr 3:299.\u003c/li\u003e\n \u003cli\u003eQuinn GR, Hellkamp AS, Hankey GJ, Becker RC, Berkowitz SD, Breithardt G, Fava M, Fox KA, Halperin JL, Mahaffey KW, Nessel CC. Selective serotonin reuptake inhibitors and bleeding risk in anticoagulated patients with atrial fibrillation: an analysis from the ROCKET AF trial. \u003cem\u003eJournal of the American Heart Association\u003c/em\u003e. 2018 Aug 7;7(15):e008755.\u003c/li\u003e\n \u003cli\u003eDalton SO, Johansen C, Mellemkj\u0026aelig;r L, S\u0026oslash;rensen HT, N\u0026oslash;rg\u0026aring;rd B, Olsen JH. Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal tract bleeding: a population-based cohort study. \u003cem\u003eArchives of internal medicine\u003c/em\u003e. 2003 Jan 13;163(1):59-64.\u003c/li\u003e\n \u003cli\u003eShahrbabki ME, Shahrbabaki AE. Sertraline-related bleeding tendency: could it be dose-dependent?. \u003cem\u003eIranian Journal of Psychiatry and Behavioral Sciences\u003c/em\u003e. 2014;8(3):81.\u003c/li\u003e\n \u003cli\u003eBlasco-Fontecilla H, de Leon J. Lower gastrointestinal bleeding and paroxetine use: two case reports. \u003cem\u003ePsychosomatics\u003c/em\u003e. 2012 Mar 1;53(2):184.\u003c/li\u003e\n \u003cli\u003eMeuret AE, Tunnell N, Roque A. Anxiety disorders and medical comorbidity: treatment implications. \u003cem\u003eAnxiety disorders\u003c/em\u003e: Rethinking and understanding recent discoveries. 2020:237-61.\u003c/li\u003e\n \u003cli\u003eDietrich-Muszalska A, Wachowicz B. Platelet haemostatic function in psychiatric disorders: Effects of antidepressants and antipsychotic drugs. \u003cem\u003eThe World Journal of Biological Psychiatry.\u003c/em\u003e 2017 Nov 17;18(8):564-74.\u003c/li\u003e\n \u003cli\u003eReddy YJ, Sudhir PM, Manjula M, Arumugham SS, Narayanaswamy JC. Clinical practice guidelines for cognitive-behavioral therapies in anxiety disorders and obsessive-compulsive and related disorders. \u003cem\u003eIndian journal of psychiatry\u003c/em\u003e. 2020 Jan;62(Suppl 2):S230.\u003c/li\u003e\n \u003cli\u003eJakobsen JC, Katakam KK, Schou A, Hellmuth SG, Stallknecht SE, Leth-M\u0026oslash;ller K, Iversen M, Banke MB, Petersen IJ, Klingenberg SL, Krogh J. Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. \u003cem\u003eBMC psychiatry\u003c/em\u003e. 2017 Dec;17(1):1-28.\u003c/li\u003e\n \u003cli\u003e2nd Multidisciplinary Scientific Conference: Ibri Regional Hospital, Ibri, Oman, 31 December 2022. (2023). \u003cem\u003eSultan Qaboos University medical journal\u003c/em\u003e, 23(2), 276\u0026ndash;283.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"SSRIs, lower gastrointestinal bleeding, panic disorder","lastPublishedDoi":"10.21203/rs.3.rs-4314191/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4314191/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSelective serotonin reuptake inhibitors (SSRIs) are a mainstay treatment for panic disorder, however a potential link to lower gastrointestinal bleeding (LGIB), particularly with Paroxetine, is unknown. We present a rare case of LGIB possibly caused by Paroxetine in a 35-year-old female with panic disorder. LGIB resolved after SSRI cessation, implying a possible causative relationship. We conducted a thorough clinical evaluation, including medical history, medication review, and endoscopic investigations. The patient complained of hematochezia, dizziness, and shortness of breath, which coincided with the start of Paroxetine for panic disorder. A colonoscopy indicated non-specific colitis, while an upper GI endoscopy revealed no abnormalities. LGIB resolved within a week of discontinuing Paroxetine, with no recurrence during following follow-up. This example adds to the little evidence pointing to a possible link between Paroxetine and LGIB in panic disorder. More research is required to understand the underlying mechanisms and confirm causality. While initially mysterious, this case eventually revealed the complicated connection between mental health, medicine, and physical manifestations. It emphasized the significance of alertness in monitoring potential side effects, the efficacy of alternative therapies such as CBT, and the importance of patient awareness in managing complex medical problems.\u003c/p\u003e","manuscriptTitle":"A case of paroxetine-induced lower gastrointestinal bleeding: A multifaceted approach to healing","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-29 12:17:39","doi":"10.21203/rs.3.rs-4314191/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"60750518-9cda-4f1f-a21e-cc87a2736a5c","owner":[],"postedDate":"April 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":31070875,"name":"Psychiatry"}],"tags":[],"updatedAt":"2024-04-29T12:17:39+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-29 12:17:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4314191","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4314191","identity":"rs-4314191","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}