Use of Selective Serotonin Reuptake Inhibitors and Risk of Upper Gastro-intestinal Tract Bleeding
Use of Selective Serotonin Reuptake Inhibitors and Risk of Upper Gastro-intestinal Tract Bleeding
Abstract & Commentary
Synopsis: SSRIs increase the risk of upper gastrointestinal bleeding, and this effect is potentiated by concomitant NSAID or aspirin use.
Source: Dalton S, et al. Arch Intern Med. 2003;163:59-64.
Selective serotonin reuptake inhibitors (SSRIs) have become extremely popular in the past 2 decades due to efficacy along with absence of significant toxicity. This Scandinavian study involved 26,005 users of antidepressants in the county of North Jutland, Denmark (total population of 490,000). SSRIs produced a 3.6-fold increase in the risk of upper GI hemorrhage (55 hospitalizations vs the expected 15.3), and their use along with NSAIDs increased risk to 12.2 fold. There were no increased risks of upper GI bleeding associated with use of antidepressants without effects on serotonin receptors. Dalton and colleagues speculate that this effect relates to the critical role of serotonin release by platelets in the overall hemostatic process and to the inability of platelets to resynthesize depleted serotonin stores.
Comment by Malcolm Robinson, MD, FACP, FACG
This interesting report provides data on a previously generally unsuspected linkage between use of SSRIs and GI hemorrhage—as well as a reasonable pathophysiologic explanation for the observation. The investigation was undertaken because of an earlier case-control study of 1651 cases of GI bleeding and 10,000 matched controls that also described a 3-fold increased risk of upper GI bleeding among users of all types of SSRIs vs nonusers.1 These 2 studies seem to provide compelling evidence of a relationship between this commonly used type of antidepressant medication and clinically important upper GI bleeding. Careful studies of platelet function should be undertaken to elucidate any measurable abnormality due to SSRI use. SSRIs are valuable drugs, but they may have this newly recognized and reported significant drawback. Further information is awaited with great interest.
Dr. Robinson is Medical
Director at Oklahoma Foundation for Digestive Research and Clinical Professor
of Medicine at the University of Oklahoma College of Medicine in Oklahoma City,
OK.
Reference
1. de Abajo FJ, et al. BMJ. 1999;319:1106-1109.
SSRIs increase the risk of upper gastrointestinal bleeding, and this effect is potentiated by concomitant NSAID or aspirin use.
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