According to this study:
* Antidepressants that block the serotonin reuptake mechanism increase the risk of upper gastrointestinal tract bleeding.
* Acid-suppressing agents may decrease this risk.
In this nested case-control study, the authors investigated the relationship between selective serotonin reuptake inhibitors (SSRIs) or venlafaxine, a selective serotonin and norepinephrine reuptake inhibitor, and upper gastrointestinal (GI) bleeding. They also sought to determine whether certain patients were at higher risk for GI bleeding and whether acid-suppressing therapies reduce the bleeding risk. Data from January 2000 to December 2005 were obtained from the United Kingdom's Health Improvement Network database. A total of 1,321 patients with upper GI bleeding were matched to 10,000 patients in a control group.
A significantly higher percentage of patients in the case group were taking SSRIs or venlafaxine (5.3% and 1.1%, respectively) than were patients in the control group (3.0% and 0.3%, respectively), indicating that SSRI use, in particular, increased the risk of GI bleeding. Venlafaxine was also shown to increase the risk of bleeding. No relationship between dose or duration of use of SSRI or venlafaxine and risk of bleeding was apparent. Concomitant administration of nonsteroidal antiinflammatory drugs (NSAIDs) or systemic corticosteroids with SSRIs or venlafaxine further increased the risk of upper GI bleeding.
Acid-suppressing agents appeared to decrease the risk of upper GI bleeding; the relative risk of bleeding was lower in those taking an SSRI or venlafaxine and an acid suppressor than in those taking an SSRI or venlafaxine without acid-suppressing therapy. Also, acid-suppressing agents decreased the risk of upper GI bleeding in those taking an SSRI or venlafaxine with an NSAID or antiplatelet medication.
The authors concluded that patients taking an SSRI or venlafaxine with an NSAID or an antiplatelet drug are at high risk for developing upper GI tract bleeding; they suggest that these patients also take an acid-suppressing agent to decrease this risk.