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Connection Between SSRIs and Abnormal Bleeding?
Selective serotonin reuptake inhibitors (SSRIs) have a history of causing problems in their users. These well documented adverse effects range from sexual dysfunction to SSRI discontinuation syndrome. However, recent research published in the November 22nd issue of the Archives of Internal Medicine shows that new users of SSRIs have an increased risk of being hospitalized for abnormal bleeding.
SSRIs are a class of antidepressants that act within the brain to increase the amount of the neurotransmitter, serotonin by inhibiting its reuptake. SSRIs are frequently prescribed for anxiety disorders, obsessive-compulsive disorder, and eating disorders. Their effectiveness does not appear to be higher than tricyclic antidepressants, which were the most commonly used class of antidepressants before the development of SSRIs. However, SSRIs are thought to have less adverse effects when compared with tricylics.
But according to this new research, case reports and observational studies have shown a relationship between SSRI use and abnormal bleeding. It is believed that serotonin plays a role in blood clotting, and because SSRIs affect serotonin levels, they may be associated with an increased risk of bleeding. Welmoed E. E. Meijer et al. at the Utrecht Institute for Pharmaceutical Sciences (Netherlands) estimated the risk of abnormal bleeding associated with antidepressant use among 64,000 new antidepressant users. Data was collected from 1992 through 2000 to conduct the case-control study. Cases were identified as all patients hospitalized for a primary diagnosis of abnormal bleeding, and they were matched with controls for age and sex. Individuals were classified according to the degree of serotonin reuptake inhibition of the antidepressants they were taking.
In the sample size, researchers found 196 cases of abnormal bleeding, including abnormal uterus and gastrointestinal bleeding. The risk of hospitalization increased with the use of drugs according to degree of inhibition. The association between degree of serotonin reuptake inhibition by antidepressants and risk of hospital admission for abnormal bleeding was found to be significant. In cases of high degree of inhibition of serotonin reuptake there was a 2.6-fold increased risk of bleeding events compared with antidepressants with a low degree of serotonin reuptake inhibition.
The association of SSRI use and abnormal bleeding has come up before. In a study conducted in January of 2003 by S.O. Dalton et al. The study included about 26,000 people who had been prescribed an antidepressant, SSRI or other, from 1990 to 1995. Participants who were taking an SSRI were three times as likely to suffer from gastrointestinal bleeding as people not taking the drugs. Among those taking an SSRI along with a nonsteroidal anti-inflammatory drug or low-dose aspirin, the risk was even higher.
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