The results from most, but not all observational studies suggest that there is an association between the use of SSRIs and upper GI bleeds. Several studies have found the use of SSRIs with concomitant NSAIDs to increase the risk of upper GI bleeding further. Being over the age of 80 or having a previous history of GI bleeding may also add to the risk of upper GI bleeding with SSRIs. Some evidence suggests that the risk is higher in patients who have just started taking SSRIs, and in those taking SSRIs with a high/intermediate affinity for the serotonin receptor, but existing evidence of heightened risk in these patient groups is too weak to draw any firm conclusions. Further work is required. If an SSRI is required in a patient at high risk of an upper GI bleed, consider the use of a gastro-protective agent. Studies have shown the use of acid suppressing drugs, e.g. PPIs, to be protective against upper GI bleeds in patients receiving single-therapy SSRI or combined NSAID and SSRI treatment. Current NICE guidance on depression recommends considering a gastroprotective drug in older people on SSRIs who are also taking NSAIDs or aspirin. Another source recommends that patients taking multiple drugs that could cause bleeding seek informed medical advice before starting regular use of non-prescription drugs such as ibuprofen. Paracetamol should be considered as an alternative to an NSAID in patients who are taking SSRIs.
Senior Information Pharmacist, Welsh Medicines Information Centre