Pharmacology
Antidepressants Plus NSAIDs and the Risk of Intracranial Hemorrhage
Study shows a cocktail of antidepressants and NSAIDs have an increasing risk of gastrointestinal bleeding.
Antidepressants—especially selective serotonin reuptake inhibitors (SSRIs)—and nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with increasing the risk of abnormal bleeding, usually gastrointestinal bleeding. Neither of the drug groups have been linked to a higher risk of intracranial hemorrhage (ICH), but little is known about that risk, say researchers from Seoul National University in South Korea. However, their analysis of data from nearly 5 million people, using both antidepressants and NSAIDs, increased the 30-day risk of ICH (hazard ratio, 1.6).
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The study included patients who began receiving antidepressants without having received a prescription for antidepressants during the preceding year. Antidepressants included serotonin-norepinephrine reuptake inhibitors, SSRIs, and tricyclic antidepressants.
Among people who used only antidepressants, the incidence rate of events was 1.6 per 1,000 person-years. Among those who used both antidepressants and NSAIDs, the rate was 5.7.
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Men had the highest risk for intracranial hemorrhage. The combined use seemed to not have a major effect on patients who already had risk factors for ICH, such as advancing age and receiving antithrombotic agents, the researchers say. They also found no statistically meaningful differences in risk of ICH among the antidepressant drug classes.
To the best of their knowledge, the researchers say, this is the first population-based cohort study focusing on the risk of ICH with combined use of antidepressants and NSAIDs. Other studies have mostly been case-control, they say, examining abnormal bleeding risk from SSRIs.
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Source: Shin J-U, Park M-J, Lee SH, et al. BMJ. 2015;351:h3517.
doi: 10.1136/bmj.h3517.