title: Selective serotonin re-uptake inhibitors and the risk of bleeding.
abstract: Despite their safety, selective serotonin re-uptake inhibitors (SSRIs) are associated with bleeding. The authors critically reviewed the medical literature on SSRIs to identify subgroups of patients at risk of bleeding complications. The authors performed a literature search using MEDLINE from 1966 to 1st September 2004 using; 'haemorrhage, serotonin uptake inhibitors and antidepressive agents' as search terms and followed up on citations in each paper that was relevant to SSRI associated bleeding. The authors reviewed 7 retrospective analytical studies and 24 case reports of bleeding in 43 different people. Analytical studies support an association between SSRI consumption and upper gastrointestinal (GI) bleeding and perioperative bleeding. Little evidence links SSRI use with intracerebral haemorrhage. The risk of GI bleeding appeared to be highest among patients consuming SSRIs with NSAIDs. Combining aspirin or NSAIDs with SSRIs may further increase the risk of bleeding. Clinicians should caution patients about combining SSRIs with aspirin or NSAIDs. Pharmacotherapy to reduce the risk of GI bleeding should be considered in high risk patients.
authors.affiliation: University of Pennsylvania, Department of Psychiatry, 3440 Market Street, Suite 370, Philadelphia, PA 19104, USA. weinrieb_b@mail.trc.upenn.edu
authors.forename: Robert M
authors.initials: RM
authors.lastname: Weinrieb
authors.forename: Marc
authors.initials: M
authors.lastname: Auriacombe
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Lynch
authors.forename: James D
authors.initials: JD
authors.lastname: Lewis
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000928:Antidepressive Agents / Q000009:adverse effects; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors