Serotonin‐affecting antidepressant use in relation to platelet reactivity

Depression is an independent risk factor of cardiovascular disease morbidity. Serotonin is a key neurotransmitter in depressive pathology, contained within platelets, and is a weak activator of platelets. Our study assessed the link between platelet reactivity traits, depression, and antidepressant (AD)-use in a large population sample. Our study was conducted in the Framingham Heart Study (n= 3,140), and AD-use (n=563) and aspirin-use (n=681) were noted. Depression was measured using the Center for Epidemiological Studies-Depression (CES-D) survey. Platelet reactivity traits were measured across multiple agonists using five distinct assays. We utilized a linear mixed effects model to test associations between platelet traits and depression, adjusting for age, sex, aspirin use, and AD-use. Similarly, we analyzed trait associations with any AD-use, serotonin-affecting ADs, and norepinephrine-affecting ADs, respectively. There were strong associations with reduced platelet function and AD-use, particularly with serotonin-affecting medications. This included lower Optimul epinephrine maximal aggregation( P=4.87E-13), U46619 ec50 (P=9.09E-11), lower LTA ADP final aggregation (P=1.03E-05), and higher LTA ADP disaggregation (P=2.28E-05). We found similar associations with serotonin-affecting ADs in an aspirin-taking subset of our sample. There were no significant associations between platelet traits and depression. In the largest study yet of AD-use and platelet function we show that antidepressants, particularly serotonin-affecting ADs, inhibit platelets. We did not find evidence that depressive symptomatology in the absence of medication is associated with altered platelet function. Our results are consistent with AD-use leading to platelet serotonin depletions, decreased stability of platelet aggregates, and overall decreased aggregation to multiple agonists, which may be a mechanism by which ADs increase risk of bleeding and decrease risk of thrombosis.

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