- MONDAY, July 7 (HealthDay News) — The widely prescribed class of
antidepressants known as SSRIs may be associated with bleeding in the
upper gastrointestinal tract, especially when taken with painkillers
called nonsteroidal anti-inflammatory drugs, a new study says.

Although reports of this effect from the selective serotonin reuptake
inhibitors family of antidepressants — which includes Prozac, Paxil and
Zoloft — have been noted before, some outside experts said the evidence
is still far from conclusive.

“Certainly, doctors should be advising patients of this finding, but
it's far from definitive,” said Dr. Ewald Horwath, professor of
psychiatry, epidemiology and public health at the University of Miami
Miller School of Medicine. “The risk of discontinuing antidepressants and
getting depression and its consequences are much greater than this drug.”

But, other experts said that the public health impact of the new
finding, if confirmed, could be significant.

“SSRIs are the most commonly prescribed psychotropic drug in the U.S.,”
said Dr. Norman Sussman, a psychopharmacologist at New York University
Langone Medical Center and associate dean of the post-graduate program at
New York University School of Medicine. “This could be a major
pharmaceutical issue.”

The findings were published in the July issue of Archives of General
Psychiatry. The study was led by researchers at the Spanish Agency for
Medicines and Healthcare Products in Madrid. The research was supported by
grants from the drug company AstraZeneca.

Some previous research has linked SSRIs with upper gastrointestinal
tract bleeding. Other research, however, has found no such association.

For the new study, the researchers looked at 1,321 patients with upper
GI bleeding who had been referred to a hospital or a specialist, and
compared them with 10,000 “control” patients with no GI bleeding.

More people who had GI bleeding (5.3 percent) were taking SSRIs,
compared to 3 percent of the controls — an increased risk of 60 percent.
Similarly, 1.1 percent of patients with GI bleeding were taking Effexor
(venlafaxine, an antidepressant related to SSRIs), compared with 0.3
percent in the control group, an almost threefold increased risk.

And there was an almost fivefold increased risk of GI bleeding among
users of SSRIs and NSAIDs or corticosteroids, and a ninefold increased
risk among those taking NSAIDs and SSRIs without acid-suppressing
agents, according to the study.

Both NSAIDs, a class of pain relievers that includes ibuprofen and
naproxen, and corticosteroids have known negative effects on the GI
tract.

There was also a “suggestion” of an interaction of SSRIs with
antiplatelet drugs, which prevent blood clots from forming.

The study authors did not find a significant association for other
types of antidepressants.

Based on these numbers, for every 2,000 people treated with one of
these antidepressants, there would be one case of upper GI tract bleeding,
higher than in the general population. But when NSAID drugs are added,
there would be one case of GI bleeding among every 250 people taking the
antidepressants, the study authors said.

“There has been a bit of controversy about the significance of this.
This is the best study to date to look at this,” said Dr. Joseph White,
associate professor of internal medicine at Texas A&M Health Science
Center College of Medicine and chief of laboratory medicine at Scott &
White Clinic. “The risk probably does appear real, but it's slight, unless
you're taking concomitant medications. If you're taking these
antidepressants along with other medications, keep it in mind and discuss
with your physician.”

The study's lead author, Dr. Francisco J. de Abajo, said: “The
increased risk of bleeding associated with SSRIs and venlafaxine is
already included in the data sheets of the products. There have been
several editorials and revisions on this matter that are referred to in my
article. What is still a matter of controversy is the interaction with
NSAIDs and the use of acid-suppressing agents as an effective minimization
measure. The contribution of our article points in that direction.”

More information

The National Institute of Mental Health has more on
depression.