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Combined Use of Antidepressants and NSAIDs Associated with Increased Risk of Bleeding

Jul 20, 2015

According to a new study, the combined use of antidepressants and a common painkiller is associated with an increased risk of intracranial bleeding.

When taken together, antidepressants and nonsteroidal anti-inflammatory drugs (NSAIDs), could increase the risk of bleeding soon after combined use begins, Medical News Today reports. The study, published in The BMJ, compared the risk of intracranial hemorrhage-bleeding inside the skull-among patients treated with antidepressants with or without NSAIDs.

Of all common chronic conditions, depression produces the greatest effects on overall health and is a particular problem in older adults, the authors write. Depression can be treated with medications such as selective serotonin reuptake inhibitors (SSRIs), but these drugs can increase the risk of gastrointestinal bleeding, according to Medical News Today. NSAIDs are also believed to increase gastrointestinal bleeding risk. When taken together, the two types of drug may interact unfavorably and it was this concern that led a group of researchers in Korea to undertake their study.

The researchers obtained data from a Korean national health insurance database for every first-time antidepressant prescription in Korea between 2009 and 2013, a cohort of 4,145,226 people. The research team also accessed NSAID prescriptions and hospital records to identify any admissions for intracranial hemorrhages within a month of a new prescription. Over the course of the study, the 30-day risk of intracranial hemorrhage was higher for patients using a combination of antidepressants and NSAIDs than it was for patients who only used antidepressants, Medical News Today reports. The researchers found no meaningful differences in intracranial bleeding risk among different forms of antidepressant, or with the age of the patients, though male patients using both types of drug had a higher intracranial bleeding risk than female patients using both.

Because of possible limitations of the study, the authors urge caution in the interpretation of their findings. Potential inaccuracy of coding, incomplete records, and unmeasured confounding factors may have influenced the results. But the authors believe that "special attention is needed when patients use both these drugs together," according to Medical News Today.

In an editorial accompanying the article, Dr. Stewart Mercer of the University of Glasgow and colleagues at the University of Cambridge explain how widely used the two forms of medication are. NSAIDs, such as Motrin, Aleve, and Advil, accounted for 13 percent of all over-the-counter drug sales in the U.S. last year. "The availability of over-the-counter analgesics is particularly important, as doctors often fail to consider the risks and potential interactions posed by nonprescribed drugs," the editorial states. "Although NSAIDs bought over the counter are often taken for a short period only, [the study] reported elevated bleeding risk within 30 days of a new prescription." And, Medical News Today explains, conditions that are treated with antidepressants and NSAIDs often coexist. For example, 65 percent of adults with major depression also suffer chronic pain. The editorial writers conclude that physicians should exercise caution when prescribing these two types of drugs and they should discuss these risks with patients. The findings may be "especially relevant" among patients in areas of "high socioeconomic deprivation," where the combination of depression and physical problems is common.

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