Study: Antidepressant and Pain Relief Combination May Increase Bleeding Risk

Combining SSRI antidepressants with NSAID pain relievers may increase the risk of intestinal bleeding, according to a new study. Photo by frolicsomepl / Pixabay

Antidepressants called selective serotonin reuptake inhibitors, or SSRIs, are the cornerstone of treatment for depression, but a new study warns that taking common pain relievers in addition to SSRIs may increase your chances of gut bleeding.

In a review of 10 published studies involving 6,000 patients, researchers found that those taking SSRIs – such as Celexa, Paxil, Prozac, and Zoloft – and pain relievers called nonsteroidal anti-inflammatory drugs, or NSAIDs, such as Advil and Aleve had an increased risk of gastrointestinal bleeding.

“When adding SSRIs to patients already on NSAIDs, the chances of developing upper gastrointestinal bleeding increased by 75%,” said principal investigator Dr. Syed Alam, chief resident of internal medicine at Creighton University School of Medicine, in Omaha, Neb.

The increased risk of upper gastrointestinal bleeding is likely due to the interaction of the two types of drugs, he said.

NSAIDs inhibit the production of prostaglandin, which protects the gastrointestinal tract, and SSRIs inhibit the production of platelets, which are necessary for clotting.

This combination therefore increases the risk of bleeding, Alam explained.

“The risk of upper gastrointestinal bleeding by adding an SSRI to an NSAID should be discussed between the patient and the doctor,” he said. “Whenever possible, it is best to reduce or stop NSAIDs before starting an SSRI to minimize the risk of upper gastrointestinal bleeding.”

Dr Elena Ivanina, director of neurogastroenterology and motility at Lenox Hill Hospital in New York City, said that in addition to the effect on platelets, SSRIs increase stomach acidity, which can lead to peptic ulcers, increasing the risk of gastrointestinal bleeding.

“Doctors and patients both need to be aware of medications that increase the risk of gastrointestinal bleeding,” she said.

“Patients should always discuss their medications with their doctor. For example, since the risk of gastrointestinal bleeding is considerably high when SSRIs are used with NSAIDs like Motrin, doctors should be cautious and consider alternative treatments. to this combination, ”said Ivanina.

Ivanina said signs of gastrointestinal bleeding may be obvious or hidden.

Gastrointestinal bleeding can cause vomiting of blood or blood in stools or black stools, she said.

“Some bleeding, however, may be microscopic and not visible, therefore symptoms of anemia such as fatigue, shortness of breath on exertion or dizziness may also signal blood loss,” Ivanina said. .

Another expert believes that because patients increasingly receive other antidepressants that also relieve pain, the risk of internal bleeding from these drugs should be investigated.

Dr Jeffrey Fudin, founder of Pharmacist Consulting Services, said it’s well known that SSRIs increase the risk of bleeding.

“Patients should also be aware that aspirin and blood thinners increase the risk of gastrointestinal bleeding with or without NSAIDs,” he said.

Indeed, the serotonin present in platelets, responsible for coagulation, is inhibited by SSRIs, which alter platelet function.

Because many doctors are reluctant to prescribe opioids, many patients are now receiving serotonin and norepinephrine reuptake inhibitors, or SNRIs, such as duloxetine, sold as Cymbalta, or milnacipran, sold as Savella’s name, both owned by the United States Food and Drug Administration. approved as antidepressants and also for pain, he said.

“Although fewer studies have examined the bleeding risks of SNRIs, it is logical to expect SNRIs to affect the risk of bleeding, although to a lesser extent than SSRIs,” Fudin said.

The results were presented Sunday at the American College of Gastroenterology annual meeting, held in Las Vegas and online. Results presented at medical meetings are considered preliminary until published in a peer-reviewed journal.

More information

To learn more about SSRIs, visit the Mayo Clinic.

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