In direct contradiction to your request, I am not helping with your maths but providing general (not specific) advice.
Bleeding has a 30% mortality rate
This depends very much on the population you are looking at (age, source of bleeding, severity of bleeding, comorbidities at time of bleeding—both acute and chronic). I would suggest that if you are not fulfilling some of these criteria your bleeding mortality is much lower. It is certainly possible that an SSRI could have a statistically significant effect in cases of severe bleeding like major trauma, but you’d have to estimate the risk that you’ll experience major bleeding.
As Cariyaga has said, acetaminophen/paracetamol is an alternative, which doesn’t have the same interaction with SSRIs. Individual doses of NSAIDs may be ok, but I don’t know if there’s any good data to support or deny this. Part of the risk with NSAIDs is that they affect coagulation AND directly cause bleeding (gastric ulceration). Past history or family history of clotting/bleeding disorders, gastric ulcers or significant gastric reflux increase the risk of this.
Another alternative is non-serotonergic antidepressants. There are many classes of antidepressant and some may not feature the same level of evidence of this increased bleeding risk (although all feature potential side-effect profiles longer than my arms). To confuse matters, some are classified structurally (tricyclic antidepressants TCAs, tetracyclic antidepressants) and some functionally (SSRIs, SNRIs, NaSSAs, RIMAs, MAOIs). TCAs may behave functionally like SSRIs, and may confer a bleeding risk as well.
I think the solution will depend on some research by yourself and some discussions with your doctor. Certainly avoiding NSAIDs is an easy first step. It is easy to get paralysed by the ocean of studies, but doing nothing may not be the right decision for your quality of life.
In direct contradiction to your request, I am not helping with your maths but providing general (not specific) advice.
This depends very much on the population you are looking at (age, source of bleeding, severity of bleeding, comorbidities at time of bleeding—both acute and chronic). I would suggest that if you are not fulfilling some of these criteria your bleeding mortality is much lower. It is certainly possible that an SSRI could have a statistically significant effect in cases of severe bleeding like major trauma, but you’d have to estimate the risk that you’ll experience major bleeding.
As Cariyaga has said, acetaminophen/paracetamol is an alternative, which doesn’t have the same interaction with SSRIs. Individual doses of NSAIDs may be ok, but I don’t know if there’s any good data to support or deny this. Part of the risk with NSAIDs is that they affect coagulation AND directly cause bleeding (gastric ulceration). Past history or family history of clotting/bleeding disorders, gastric ulcers or significant gastric reflux increase the risk of this.
Another alternative is non-serotonergic antidepressants. There are many classes of antidepressant and some may not feature the same level of evidence of this increased bleeding risk (although all feature potential side-effect profiles longer than my arms). To confuse matters, some are classified structurally (tricyclic antidepressants TCAs, tetracyclic antidepressants) and some functionally (SSRIs, SNRIs, NaSSAs, RIMAs, MAOIs). TCAs may behave functionally like SSRIs, and may confer a bleeding risk as well.
I think the solution will depend on some research by yourself and some discussions with your doctor. Certainly avoiding NSAIDs is an easy first step. It is easy to get paralysed by the ocean of studies, but doing nothing may not be the right decision for your quality of life.
Thank you very much.