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SSRI Bleeding Risk — MRCPsych Paper B MCQ

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ModerateMood DisordersSSRI Bleeding RiskMRCPsych Paper B

A 65-year-old man with a major depressive episode takes aspirin 75 mg daily for secondary prevention following a myocardial infarction. Sertraline is being considered. Which statement best describes the clinically important interaction?

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Reveal the answer and explanation

Correct answer: C — Bleeding risk is increased because sertraline inhibits platelet serotonin uptake and impairs platelet-mediated haemostasis

Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as E

B is correct. Sertraline and other SSRIs inhibit serotonin uptake into platelets. Because platelets cannot synthesise serotonin, continued treatment reduces platelet serotonin availability and weakens platelet-mediated haemostasis. Aspirin independently inhibits platelet function, so concurrent treatment produces an additive risk of bleeding, including gastrointestinal bleeding. The sertraline SmPC therefore advises caution with aspirin, NSAIDs and anticoagulants. Sertraline does not induce aspirin metabolism or reduce its antiplatelet action, so C is incorrect. SSRIs do not enhance platelet activation or characteristically cause thrombosis, excluding D. This is a class-related SSRI interaction rather than one confined to paroxetine, excluding E; consequently, A is also incorrect.

Reference: Electronic Medicines Compendium. Sertraline 100 mg Tablets, Summary of Product Characteristics, sections 4.4, 4.5 and 5.1. Updated 5 June 2026. https://www.medicines.org.uk/emc/product/5759/smpc