Common Depression and Anxiety Drugs Increase Risk for Gastrointestinal Bleeding, Research Shows

Research conducted at Wake Forest University School of Medicine has shown a strong link between the use of SSRIs, a class of drugs commonly prescribed for mood disorders such as depression and anxiety, and gastrointestinal bleeding. The study suggests that taking SSRIs could double the risk for gastrointestinal bleeding, while the use of NSAID (non-steroidal anti-inflammatory drugs) pain relievers such as aspirin increased the risk by six-fold.

Dr. Sonal Singh, M.D., senior researcher for the study, advised caution when prescribing the medications. "Clinicians who prescribe these medications should be aware of the potential risk and may need to consider alternatives," said Singh. "In addition, regulatory authorities should consider revising existing package inserts to highlight the magnitude of the risk."

The type of bleeding that has been seen involves the lining of the upper gastrointestinal (GI) digestive tract, and included the esophagus, stomach or upper part of the small intestine. Serious upper GI bleeding can require hospitalization for blood transfusion or other treatments.

Research into the link between SSRIs and gastrointestinal bleeding began because there was little existing information on potential risks. The researchers included the contributing factors of NSAIDs such as Aleve, Celebrex, and aspirin, because the drugs have already been shown to contribute to GI bleeding.

"These findings emphasize the importance of clinicians taking a detailed gastrointestinal history from patients and targeting the use of SSRIs to patients who are at relatively low risk for upper GI bleeding," said Singh.

Data from four studies involving over 150,000 patients was studied, allowing researchers to identify trends that might not appear in isolated studies. Patients taking SSRIs alone were shown to develop GI bleeding twice as often as patients taking none, while patients taking SSRIs and NSAIDs developed bleeding more than six times as often.

"We estimate that roughly 18,000 additional cases of upper GI bleeding occurred in the United States and United Kingdom in 2003 as a result of taking SSRIs," said Singh.

Singh said that older adults, who often suffer from depression and osteoarthritis (requiring the use of pain relievers), were most at risk from the apparent synergy of the two types of drugs. No distinction was made between specific brands of drugs and their likelihood to contribute to bleeding.

"While the risk to an individual may increase by only a small amount, the impact to the general population is likely to be substantial because of the large numbers of people who use these drugs," said Singh.

Wake Forest University Baptist Medical Center, Anti-Depressant Drugs Can Double Risk of Gastrointestinal Bleeding, Research Show