MedWire News: Antidepressants called selective serotonin reuptake inhibitors may increase the risk of bleeding in the upper gastrointestinal tract, such as in the stomach, study results show.

However, the researchers found that stomach-acid suppressing drugs, such as proton pump inhibitors, reduced the risk of bleeding associated with selective serotonin reuptake inhibitors.

Dr Francisco de Abajo, from the Spanish Agency for Medicines and Healthcare Products in Madrid, and Dr Luis García-Rodríguez, from the Spanish Centre for Pharmacoepidemiologic Research in Madrid explain: "Selective serotonin reuptake inhibitors have been reported to increase the risk of upper gastrointestinal tract bleeding.

"The wide use of these drugs makes such potential risk a public health concern, and identification of factors that may increase or minimise such risk is necessary."

The team therefore studied the use of selective serotonin reuptake inhibitors among 1321 patients who had been referred to a consultant or hospitalised for upper gastrointestinal bleeding between 2001 and 2005.

For comparison, they also studied the use of these antidepressants among 10,000 patients who did not have upper gastrointestinal bleeding.

Analysis revealed that the use of selective serotonin reuptake inhibitors was associated with a 1.6-fold increased risk of upper gastrointestinal bleeding.

This risk was much higher (4.8-fold) when patients used these antidepressants in combination with non-steroidal anti-inflammatory drugs, which are known to be harmful to the stomach.

However, the use of stomach acid-suppressing medications significantly reduced the risk of bleeding associated with taking these antidepressants and non-steroidal anti-inflammatory drugs.

"The results obtained in the present study support the hypothesis that selective serotonin reuptake inhibitors as a group increase the risk of upper gastrointestinal tract bleeding," Drs de Abajo and García-Rodríguez conclude in the Archives of Psychiatry.

They add: "The results also suggest that use of acid-suppressing agents lowers the risk of upper gastrointestinal tract bleeding associated with serotonin reuptake inhibitors and, in particular, the combined effect of their concomitant use with nonsteroidal anti-inflammatory drugs."