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In People on NSAIDs, SSRI Antidepressant May Further Up Risk of GI Bleeding

NEW YORK (Reuters Health) – Adding a selective serotonin-reuptake inhibitor (SSRI) significantly increases the odds of developing an upper gastrointestinal bleed in patients already on non-steroidal anti-inflammatory drugs (NSAID), according to results of a systemic review and meta-analysis.

“It is known that NSAID use increases the risk for upper GI bleeding and previous studies have shown that SSRIs can also increase the likelihood of upper GI bleeding by compromising platelet aggregation in primary hemostasis,” said Dr. Syed Mobashshir Alam in a presentation of the study at the American College of Gastroenterology annual meeting.

Based on data from 10 different studies, Dr. Alam and colleagues from Creighton University School of Medicine in Omaha, Nebraska, found a 75% increase in the odds of GI bleeding with concomitant use of NSAIDs and SSRIs (95% confidence interval, 32% to 133%).

“To put this more in perspective, the number needed to harm for upper GI bleeding when using both NSAIDs and SSRI was 12,” Dr. Alam reported.

“Clinicians need to weigh the risk and benefits of adding SSRI therapy if the use of NSAIDs cannot be discontinued,” he told attendees.

“If there is a need to add SSRIs in patients who are regularly taking NSAIDs, it is important to discuss the risks of potentially life-threatening GI bleeding. It is best to minimize, if not discontinue, NSAIDs altogether prior to starting an SSRI,” he said.

If this is not possible, use of acid suppressing agents such as proton-pump inhibitors (PPI) is a potential therapy to curb the rates of upper GI bleeding though the data on this is limited, he said.

“Further investigation of patients on SSRIs and NSAIDs with and without PPIs needs to be established before determining the true risk of developing an upper GI bleed,” he concluded.

The study had no specific funding and the authors have no relevant disclosures.

SOURCE: American College of Gastroenterology Annual Scientific Meeting, presented October 25, 2021.

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