NSAIDS and Antidepressants

Use Of Antidepressants With NSAIDs Or Aspirin Linked To GI Bleeding

URL: http://www.pslgroup.com/dg/13D2F6.htm

Doctor's Guide
October 22, 1999

LONDON, UK -- October 22, 1999 -- People taking the class of antidepressant called selective serotonin reuptake inhibitors (SRIs) have an increased risk of upper gastrointestinal (GI) bleeding, claim researchers from Spain in this week's British Medical Journal. Although the risk is three times greater than those not taking antidepressants, in absolute terms the risk is moderate (estimated to affect one person in 8,000 taking antidepressants), say the authors.

Dr. Francisco Jos de Abajo and colleagues from Madrid studied 1651 people who had suffered upper GI bleeding (cases) and compared them to a control group of 10,000 who did not have upper GI bleeding.They found that 3.1 percent of case patients had been taking selective SRIs as opposed to only one percent in the control group.

The risk is similar to that of low dose ibuprofen, say the authors but their study suggests that when selective SRIs are taken with non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin, the risk of bleeding is greatly increased.

The researchers say these findings may have important public health implications owing to the high prevalence of both antidepressants and NSAIDs in most developed countries.

In a linked editorial Professor Alain Li Wan Po, from the Centre for Evidence-Based Pharmacotherapy at Aston University, in Birmingham, UK, writes that further studies are needed to confirm the results of de Abajo et al's study. He argues that the term "serotonin reuptake inhibitor" is not well defined in the paper and that this could cause confusion when interpreting de Abajo et al's findings. However, Li Wan Po advises prescribers that although there may be alternative explanations other than the drug for the observed increase in risk of gastrointestinal bleeding "...greater caution is probably warranted in co-administering non-steroidal anti-inflammatory drugs and serotonin reuptake inhibitors."

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