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Posted by on Sep 15, 2018 in Stroke | 0 comments

In a nutshell

This study looked at the association between antidepressant medication and abnormal bleeding. The authors stated that antidepressants increase the risk of abnormal bleeding, particularly when combined with nonsteroidal anti-inflammatory drugs (NSAIDs). 

Some background

Serotonin reuptake inhibitors (SRIs) are used to treat depression, anxiety and pain disorders. They work by increasing levels of available serotonin (a chemical) in the brain. It is thought that SRIs can lead to abnormal bleeding, as they prevent platelets (blood cells involved in blood clotting) from clotting. It is also possible that different SRIs may cause worse abnormal bleeding than others, such as selective serotonin reuptake inhibitors (SSRIs). 

Other drugs, such as NSAIDs are known to prevent platelet clotting. NSAIDs are used frequently to lower the risk of stroke and heart attacks (antiplatelet therapy). It is still unknown how can the risk of bleeding with the use of SRIs be prevented in these patients.

Methods & findings

This study analyzed data from 10 other studies. 

The authors found that SRIs increased the risk of abnormal bleeding by 41%. Specifically, the risk of gastrointestinal (GI; stomach and intestines) bleeds was increased by 55%. The risk of brain bleeds was increased by 16%. Women on antidepressant medication had a 32% increased risk of bleeding after giving birth. Some studies found the risk of GI bleeds was increased up to 2.36-fold among SRI users.

The authors looked at whether taking other drugs alongside SRIs could influence the risk of abnormal bleeding. Combining SSRIs with antiplatelet and NSAIDs increased the risk of bleeding by 42% with one antiplatelet drug and by 57% with two antiplatelet drugs.

The authors state that acid-reducing medications may be beneficial for lowering the risk of bleeding associated with SRIs and NSAIDs. Other studies showed that antidepressants that bind weaker to serotonin may not increase the risk of abnormal bleeding. 

The bottom line

The authors concluded that SRIs increase the risk of abnormal bleeding, particularly in combination with NSAIDs. 

The fine print

Several of the studies used for this analysis had small sample sizes. More research is needed to fully understand the association between SRIs and abnormal bleeding. 

What’s next?

If you have any concerns regarding the use of antidepressants and the risk of bleeding, consult with your doctor.

Published By :

The Annals of pharmacotherapy

Date :

Aug 06, 2018

Original Title :
Clinical Management of Bleeding Risk With Antidepressants.
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