Study: SSRIs Use Tied to Upper GI Bleeds

ssri_tied_to_gi_tract_bleedingThe use of selective serotonin reuptake inhibitors (SSRIs) for as little as seven days presents significant increased risks for upper gastrointestinal (GI) bleeding events, according to a new study.

“Consistent with previous studies, SSRIs were the only antidepressants found to have increased risk of upper GI bleeding,” lead investigator Ching-Liang Lu, MD, National Yang-Ming University in Taipei, Taiwan, told Medscape Medical News. “… Doctors are not well aware of this phenomenon in current practice,” he noted. The study was published online September 13 in the American Journal of Psychiatry.

SSRIs include drugs such as Celexa, Desyrel, Lexapro, Luvox, Luvox CR, Oleptro, Paxil, Paxil CR, Pexeva, Prozac, Sarafem, Serzon, Symbyax, Vilbryd, and Zoloft. SSRIs are indicated for the treatment of major depressive disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder, anxiety disorders, bulimia nervosa, and premenstrual dysphoric disorder (PMDD), and are typically used in the treatment of depression. These medications have different indications and active ingredients; not all SSRIs treat the same conditions. It is believed that SSRIs increase serotonin levels in the brain.

The researchers looked at risks for upper GI bleeds tied to SSRIs for shorter periods, using data from the Taiwan National Health Insurance Database, and compared antidepressant use rates—case and control periods—for time frames of 7, 14, and 28 days. A total of 5377 patients with upper GI bleeding were enrolled in the study, according to Medscape Medical News.

Prozac (fluoxetine) and Zoloft (sertraline) were both associated with an elevated risk for upper GI bleeding and Celexa (citalopram), Paxil (paroxetine), and Lexapro (escitalopram) were also associated with an elevated bleeding risk that was just shy of being statistically significant, which according to Medscape Medical News was likely do to the small sample size. “A combination of SSRI and nonsteroidal anti-inflammatory drugs [NSAIDs] would further increase the risk of upper GI bleeding,” said Dr. Lu.

A prior, population-based cohort study published in 2003 revealed increased risks for GI bleeding with SSRI therapy, especially when combined with NSAIDs, according to Medscape Medical News.

We recently wrote that another study revealed that patients taking SSRIs during the perioperative period (from hospitalization admission to discharge) were at increased risks for suffering an adverse event. The study appeared in the April 29, 2013 issue of JAMA Internal Medicine, according Drug Safety Monitor. We also previously wrote that a study found an increased risk of developing an autism spectrum disorder (ASD) in children whose mothers took specific antidepressant medications, including SSRIs. This was the second study in two years to associate antidepressant use during pregnancy with an increased likelihood of exposed children being diagnosed with autism. A prior study suggested that there is too much of a risk taking SSRIs during pregnancy, including potential increased risks for miscarriage, pre-term births, neonatal health complications, and long-term neurobehavioral abnormalities including autism.

Prior to that, we wrote that a growing body of research linked SSRIs to birth defects and other issues when used by pregnant women, especially in the early months of pregnancy when many women don’t realize they are pregnant. One study published by researchers at Sweden’s Karolinska Institute found that taking an SSRI antidepressant during pregnancy was associated with a two-fold increased risk of neonatal pulmonary hypertension (PPHN). Another report published in the Archives of General Psychiatry found that babies exposed to SSRI antidepressants before birth exhibit reduced head growth at birth, and are more likely to be born prematurely.

Researchers at Canada’s McMaster University discovered that antidepressants that impact levels of serotonin in the brain can cause side effects related to any bodily process normally regulated by serotonin. Some possible side effects include birth defects in infants; sexual dysfunction, and problems with sperm development in adults; diarrhea, constipation, indigestion, bloating, and other digestive problems; and abnormal bleeding and stroke in the elderly.

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