1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Serotonin-Inhibiting Antidepressants Increase GI Bleeding Risk in Older Patients

Serotonin potentiates platelet aggregation, and selective serotonin reuptake inhibitors (SSRIs) and other serotonin-inhibiting antidepressants decrease the amount of serotonin in platelets. Canadian investigators performed this retrospective cohort study to evaluate whether use of serotonin-inhibiting antidepressants is associated with gastrointestinal (GI) bleeding in older patients.

Using population-based databases, the researchers evaluated 317,824 people older than 65 who received prescriptions for antidepressants. From July 1992 through April 1998, there were 974 hospital admissions for GI bleeding (7.3 per 1000 patient-years). When patients were classified by degree of serotonin-uptake inhibition (low, medium, high) associated with their antidepressant prescriptions, there was a modest upward trend in risk for GI bleeding with increasing inhibition. However, for certain patient groups, risk for bleeding rose significantly with increasing inhibition class. Thus, for octogenarians, risk for bleeding increased from 10.6 per 1000 patient-years in the lowest serotonin-inhibition group to 14.7 per 1000 patient-years in the highest group. For patients with histories of peptic ulcer disease, risk increased from 28.6 to 40.3 per 1000 person-years.

Comment: These results suggest that risk for GI bleeding increases as serotonin-inhibiting activity of antidepressants increases. The magnitude of this effect may be clinically important in the very old and in patients with histories of peptic ulcer disease. Keep in mind that, in this study, the drugs with the highest levels of serotonin reuptake inhibition included not only SSRIs (paroxetine, fluoxetine, and sertraline) but also the tricyclic antidepressant clomipramine. At the time of publication, the full text of the original article was available at http://www.bmj.com/cgi/content/full/323/7314/655 free of charge.

— KI Marton

Published in Journal Watch General Medicine October 16, 2001

Citation(s):

van Walraven C et al. Inhibition of serotonin reuptake by antidepressants and upper gastrointestinal bleeding in elderly patients: Retrospective cohort study. BMJ 2001 Sep 22 323 655-658.

• Original article (Subscription may be required)
• Medline abstract (Free)