SSRIs Boost Odds of Internal Bleeding
Gastrointestinal risk is highest with antidepressant/NSAID combo

(HealthDay News) -- The commonly prescribed antidepressants known as selective serotonin reuptake inhibitors, or SSRIs, can increase the chances of a person developing serious bleeding in the gastrointestinal tract, researchers have found.

One study suggested that one of every 82 people who take both an SSRI and pain-relievers known as NSAIDs, or non-steroidal anti-inflammatory drugs, develops bleeding in the upper gastrointestinal (GI) tract that's serious enough to require hospitalization. Antidepressants alone have a serious GI bleeding risk of about one in every 411 people taking them, according to the study, which was published in Alimentary Pharmacology and Therapeutics .

"Clinicians who prescribe these medications should be aware of the potential risk and may need to consider alternatives," senior researcher Dr. Sonal Singh, assistant professor of internal medicine at Wake Forest University School of Medicine, said in a prepared statement.

SSRIs have been shown to help many people who are clinically depressed, and they're also prescribed to treat panic disorder and obsessive-compulsive disorder. They work by changing the balance of the brain's chemical transmitters, such as serotonin and norepinephrine, according to the American Academy of Family Physicians. Known side effects of the medications -- which include paroxetine (Paxil), sertraline (Zoloft) and fluoxetine (Prozac) -- include nausea, blurred vision, constipation, diarrhea, dizziness, fatigue, dry mouth, sexual dysfunction, weight gain and tremor, according to the association.

The Wake Forest researchers pooled data from four studies, involving more than 150,000 people in all. More than two-thirds of them had taken both SSRIs and NSAIDs. Overall, people taking SSRIs were twice as likely to have an upper GI bleed than were people not taking the drugs. Someone who took both an SSRI and NSAIDs had a 600 percent higher risk of GI bleeding than did someone who took neither medication.

"While the risk to an individual may increase by only a small amount, the impact to the general population is likely to be substantial because of the large numbers of people who use these drugs," Singh said. The researchers estimated that about 18,000 additional cases of upper GI bleeding occurred in the United States and the United Kingdom in one year as a result of people taking SSRIs, he said.

Problems tended to occur after about 25 weeks on the medications, the study reported. Although older people appeared to be most at risk of side effects, 38 percent of the GI bleeds occurred in people younger than 60.

"These findings emphasize the importance of clinicians taking a detailed gastrointestinal history from patients and targeting the use of SSRIs to patients who are at relatively low risk for upper GI bleeding," Singh said.

The family physicians group reports that most side effects that occur with SSRI use go away on their own. But if they don't, it says, a doctor should be consulted right away. It might be possible to lower the dose of the medication or switch to another medication that's less apt to cause side effects.

On the Web

Learn more about depression and treatment options by visiting the National Institute of Mental Health online.

SOURCES: HealthDay News ; Wake Forest University Baptist Medical Center , news release, Oct. 8, 2007; American Academy of Family Physicians (www.familydoctor.org)
Author: Serena Gordon
Publication Date: Oct. 31, 2008
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