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SSRIs and Gastrointestinal Bleeding
Although bleeding disorders associated with the use of SSRIs have been reported infrequently, this population-based, case-controlled study, using the U.K. general-practice research database, suggests a small increased risk of upper gastrointestinal bleeding in patients using SSRIs, especially when also using nonsteroidal anti-inflammatory drugs (NSAIDs).
From April 1993 to September 1997, researchers compared 1651 patients (ages, 40 to 79) with upper GI bleeding to 10,000 controls. Incidence of SSRI use within 30 days of bleeding was 3.1% versus 1.0% in controls; GI bleeding was also associated with antidepressants with some serotonin effect (e.g., amitriptyline and trazodone, but not nortriptyline). Incidence of bleeding increased to 16% in patients taking SSRIs and NSAIDs, compared with 9% in controls using NSAIDs (relative risk, 15.6). SSRI dosage, age, or gender did not affect the results. The crude ratio of GI bleeding was estimated at 1 of 8000 prescriptions (similar to ibuprofen).
Comment: During vascular injury, serotonin is released from platelets, and SSRIs block serotonin reuptake in platelets and deplete them of serotonin. In some patients, SSRIs and perhaps other antidepressants (but not TCAs) that affect serotonin may interfere with hemostatic functions, leading to an increased risk of bleeding. If this were so, however, one would expect more frequent complaints of bleeding. Nevertheless, a patient with a diathesis for bleeding or gastrointestinal disorders should be warned about the risk of bleeding, especially when combined with nonsteroidal anti-inflammatory drugs. These data might also indicate caution in using trazodone as a sleeping medication concurrently with SSRIs. On the other hand, the platelet effects may be helpful to the heart. By inhibiting platelet activation and/or aggregation in depressed patients who show a clearly increased risk for stroke and mild myocardial infarction, SSRIs may obviate this risk while improving the patients' mood (see Am J Psychiatry 1996; 153:1313).
— G Tucker
Published in Journal Watch Psychiatry January 1, 2000
Citation(s):
de Abajo JF et al. Association between selective serotonin reuptake inhibitors and upper gastrointestinal bleeding. BMJ 1999 Oct 23 319 1-5.
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