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SSRIs and Risk for GI Bleeding

Patients who took SSRIs were at risk for hospitalization for GI bleeding; the combined use of SSRIs and NSAIDs posed especially high risks.

Just as SSRIs inhibit serotonin reuptake in the brain, they also deplete serotonin from platelets. Serotonin in platelets plays an important role in hemostasis, and there have been case reports of prolonged bleeding time, ecchymosis, purpura, and epistaxis in SSRI users. These authors report the results of the first large, population-based, cohort study of the effect of SSRIs on gastrointestinal bleeding.

Investigators used the Pharmaco-Epidemiologic Prescription Database of North Jutland, Denmark, to identify adult residents who took antidepressants between 1991 and 1995 and then linked the data to the county's Hospital Discharge Register. After excluding patients with cirrhosis, alcoholism, or histories of GI bleeding before antidepressant use, investigators determined the rates of upper GI bleeding associated with antidepressant use and concomitant medications in 26,005 residents (17,691 women).

The incidence rate of hospitalization for GI bleeds in SSRI users was 3.6 times the rate in nonusers of antidepressants; the hospitalization rate was even higher when SSRIs were used with nonsteroidal anti-inflammatory drugs or aspirin (risk ratios, 12.2 and 5.2, respectively). Antidepressants that act on both serotonin and norepinephrine were associated with a risk ratio of 2.3. Antidepressants without serotonin-transporter action showed no significant effect on the risk for GI bleeding. In patients who terminated SSRI use, the risk for GI bleeding returned to unity.

Comment: Despite excluding patients with disease related to GI bleeding, this study lacks clinical detail (e.g., smoking, alcohol, or GI infection history), and two thirds of antidepressant users were women. Still, clinicians should be aware of the bleeding potential in patients who are treated with SSRIs, particularly in patients who are also taking NSAIDs.

— Gary Tucker, MD

Published in Journal Watch Psychiatry May 7, 2003

Citation(s):

Dalton SO et al. Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal tract bleeding: A population-based cohort study. Arch Intern Med 2003 Jan 13; 163:59-64.

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