SSRIs Linked to GI Bleeding

(July 8, 2008) - A class of antidepressants (Read about "Depressive Illnesses") known as selective serotonin reuptake inhibitors (SSRIs) appear to be associated with bleeding in the upper gastrointestinal tract. (Read about "Gastrointestinal Bleeding") That's the conclusion of a study in the Archives of General Psychiatry, one of the JAMA/Archives journals.

The effects appear increased when antidepressants are combined with other stomach-harming medications and decreased when acid-suppressing agents are used. (Read about "Medicine Safety")

Since the early 1990s, case reports have suggested an association between SSRIs and bleeding in the upper gastrointestinal (GI) tract, according to background information in the article. "The wide use of this drug class requires research to provide more accurate risk estimates, to identify factors that may further increase the risk and, in particular, to determine whether using acid-suppressing agents may reduce the risk," the authors write. "It is also important to determine whether venlafaxine hydrochloride, a new antidepressant related to SSRIs, also increases the risk of bleeding, as some individual case reports have suggested."

Researchers studied 1,321 patients who had been referred to a specialist or hospitalized for upper GI bleeding. These cases were compared with 10,000 control subjects who were the same age and sex but did not have upper GI bleeding.

Individuals with upper GI bleeding were significantly more likely than controls to be taking SSRIs (5.3 percent vs. 3.0 percent) or venlafaxine (1.1 percent vs. 0.3 percent). The risk of bleeding appeared to be increased further among those taking both SSRIs and other drugs known to be harmful to the GI tract, including non-steroidal anti-inflammatory drugs (NSAIDs, which include pain relievers such as ibuprofen or naproxen) and corticosteroids. Acid-suppressing agents, however, were associated with a reduced risk of upper GI bleeding in those taking SSRIs or venlafaxine.