Drugs to fight depression may trigger bleeding

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Drugs to fight depression may trigger bleeding

 

By ANDRÉ PICARD

PUBLIC HEALTH REPORTER

Thursday, November 25, 2004 - Page A21

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Patients who take a popular form of antidepressants are at risk of

abnormal bleeding, according to a new study.

 

The drugs, known as selective serotonin reuptake inhibitors, or SSRIs,

interfere with clotting and can provoke bleeding in the stomach, the

vagina and even the brain, researchers found.

 

The research, published in this week's edition of the Archives of

Internal Medicine, noted that, ironically, the better the drugs work,

the greater the risk of bleeding.

 

SSRIs include fluoxetine (sold under the brand name Prozac) and

paroxetine (Paxil). They work by stimulating production of the brain

chemical serotonin, which is believed to regulate depression and

anxiety. But serotonin also helps regulate blood clotting.

 

" We found a significant association between [the] degree of

serotonin-reuptake inhibition by antidepressants, and risk of hospital

admission for abnormal bleeding, " said Welmoed Meijer, a

pharmacoepidemiologist at the Utrecht Institute for Pharmaceutical

Sciences in the Netherlands.

 

The study was conducted on a group of 64,000 antidepressant users

between 1992 and 2000. Individuals were classified according to the

degree (high, intermediate, or low) of serotonin-reuptake inhibition of

the antidepressants they were taking.

 

Among study participants, there were 196 cases of abnormal bleeding --

including abnormal uterus bleeding and gastrointestinal bleeding.

 

" We found a significant association between degree of serotonin reuptake

inhibition by antidepressants and risk of hospital admission for

abnormal bleeding, " the researchers wrote.

 

Dr. Meijer said that while very few patients actually experienced the

side effects, it is significant that patients who took SSRIs were three

times more likely to suffer from bleeding than those who took other

kinds of antidepressants.

 

He said bleeding incidents were far more severe in people taking

non-steroidal anti-inflammatory drugs, which range from over-the-counter

products such as acetylsalicylic acid (Aspirin), ibuprofen (Advil,

Motrin) prescription drugs such as rofecoxib (Vioxx) and celecoxib

(Celebrex), because those commonly used drugs also affect clotting.

 

Dr. Meijer said the study almost certainly underestimated bleeding

because it looked only at hospital admissions. The practical information

physicians and consumers should retain, he said, is that SSRIs may not

be appropriate for some people, particularly those who have blood

disorders such as hemophilia or anemia, those who have ulcers, and women

who suffer from heavy menstrual bleeding.

 

SSRIs have been in the news of late because of reports that use of the

antidepressants may actually increase the risk of suicide, particularly

among children and adolescents.

 

Health Canada has warned that pregnant women should avoid taking a broad

range of antidepressants, including SSRIs. It also cautioned that

children and adolescents taking SSRIs should be monitored, particularly

for suicidal thoughts.

 

According to IMS Canada, a company that tracks prescription-drug trends,

there were 15.7 million prescriptions last year for SSRIs. Sales topped

$990-million in 2003. Paxil alone has sales of more than $280-million a

year.