GPs should consider carefully the increased risk of bleeding and stroke with newer antidepressants before prescribing them, say US researchers.
Their study looked at the records of 36,000 patients with a diagnosis of major depression taking serotonin transporter inhibitors (SSRIs) as monotherapy, and the frequency of bleeding complications over 19 years.
SSRIs were categorised into ‘high’, ‘moderate’ or ‘low’ affinity for the serotonin transporter and patients with multiple prescriptions and those on tricyclic antidepressants or monoamine oxidase inhibitors were excluded.
Over 600 bleeds were observed in the 21,000 patients in the high-affinity group, compared with 333 among the 15,000 patients in the low affinity group, and this equated to a risk ratio of 1.17.
Stroke risk was also elevated in the high affinity group compared with the low affinity group, with a risk ratio of 1.18.
Study lead Dr Patience Gallagher, clinical research coordinator at Massachusetts General Hospital, said: ‘Our results add to a growing body of evidence that some newer antidepressants may be associated with elevated risks of gastrointestinal bleeding and stroke.
‘If confirmed by further investigation, it may be possible to achieve these benefits while minimising risk by selecting antidepressants with lesser affinity for serotonin transporter.’
BMJ Open 2012, online 3 April