Some antidepressants increase the risk of gastrointestinal bleeding -- especially when taken with NSAIDS or aspirin

October 21, 1999

Association between selective serotonin reuptake inhibitors and upper gastrointestinal bleeding: population based case-control study

Antidepressants and upper gastrointestinal bleeding

People taking selective serotonin reuptake inhibitors (a type of antidepressant) have an increased risk of upper gastrointestinal bleeding, claim researchers from Spain in this week's BMJ. 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 gastrointestinal bleeding (cases) and compared them to a control group of 10,000 who did not have upper gastrointestinal bleeding. They found that 3.1 per cent of case patients had been taking selective SRIs as opposed to only one per cent 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. They say that this finding 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, 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."

Dr Francisco Jos de Abajo, Head, Divisin de Farmacoepidemiologa y Farmacovigilancia, Agencia Espaola del Medicamento, Madrid, Spain

Professor Alain Li Wan Po, Director, Centre for Evidence-Baed Pahrmacotherapy, School of Life and Health Sciences, Aston University, Birmingham Email


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