SSRIs May Increase Risk of Gastrointestinal Bleeding

According to researchers from Wake Forest University School of Medicine, taking an antidepressant from the group called selective serotonin reuptake inhibitors (SSRIs) may double your risk of gastrointestinal bleeding. If you take aspirin or similar painkillers with an SSRI, your risk becomes more than six times greater.

Emerging evidence has shown that SSRIs may be associated with bleeding of the lining of the digestive tract, including the esophagus, stomach or upper part of the small intestine. This bleeding may be potentially serious and require hospitalization for blood transfusions and other treatments.

In order to assess the amount of risk, the researchers pooled data from four studies involving 153,000 patients. They found that the patients who took an SSRI had twice the risk of gastrointestinal bleeding as those who did not take one. If patients were also taking non-steroidal anti-inflammatory drugs (NSAIDs)--such as Celebrex®, aspirin or Aleve®--the risk jumped to six times greater, leading the researchers to speculate that there might be a synergistic effect between SSRIs and NSAIDs which created a greater risk than taking either of the drug types alone.

While the researchers did not attempt to evaluate which antidepressants were most associated with bleeding, previous studies have implicated paroxetine (Paxil®), sertraline (Zoloft®) and fluoxetine (Prozac®) as being most often associated with abnormal bleeding.

Sonal Singh, M.D., senior researcher and an assistant professor of internal medicine at Wake Forest University School of Medicine suggests that the elderly, who may be taking NSAIDs for conditions like osteoarthritis, may be at particular risk for gastrointestinal bleeding. "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," said Singh.

The research was reported online this month in Alimentary Pharmacology & Therapeutics.