Inhibition of serotonin reuptake by antidepressants and upper gastrointestinal bleeding in elderly patients : retrospective cohort study

OBJECTIVES: To determine the association between inhibition of serotonin reuptake by antidepressants and upper gastrointestinal bleeding. DESIGN: Retrospective cohort study from population based databases. SETTING: Ontario, Canada. Participants: 317 824 elderly people observed for more than 130 000...

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Published inBMJ. British medical journal (International ed.) Vol. 323; no. 7314; pp. 655 - 658
Main Authors VAN WALRAVEN, C, MAMDANI, M. M, WELLS, P. S, WILLIAMS, J. I
Format Journal Article
LanguageEnglish
Published London British Medical Association 22.09.2001
BMJ Publishing Group
EditionInternational edition
Subjects
Antidepressants
Biological and medical sciences
Digestive system
Drug toxicity and drugs side effects treatment
Hemorrhage
Medical sciences
Older people
Pharmacology. Drug treatments
Side effects
Toxicity: digestive system
Human
Serotonin
Cardiovascular disease
Gastrointestinal
Reuptake inhibitor
Hemorrhage
Vascular disease
Chemotherapy
Cohort study
Risk factor
Secondary effect
Digestive diseases
Intestinal disease
Antidepressant agent
Complication
Elderly
Gastric disease
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Summary:OBJECTIVES: To determine the association between inhibition of serotonin reuptake by antidepressants and upper gastrointestinal bleeding. DESIGN: Retrospective cohort study from population based databases. SETTING: Ontario, Canada. Participants: 317 824 elderly people observed for more than 130 000 person years. The patients started taking an antidepressant between 1992 and 1998 and were grouped by how much the drug inhibited serotonin reuptake. Patients were observed until they stopped the drug, had an upper gastrointestinal bleed, or died or the study ended. MAIN OUTCOME MEASURE: Admission to hospital for acute upper gastrointestinal bleeding. RESULTS: Overall, 974 bleeds were observed, with an overall bleeding rate of 7.3 per 1000 person years. After controlling for age or previous gastrointestinal bleeding, the risk of bleeding significantly increased by 10.7% and 9.8%, respectively, with increasing inhibition of serotonin reuptake. Absolute differences in bleeding between antidepressant groups were greatest for octogenarians (low inhibition of serotonin reuptake, 10.6 bleeds/1000 person years v high inhibition of serotonin reuptake, 14.7 bleeds/1000 person years; number needed to harm 244) and those with previous upper gastrointestinal bleeding (low, 28.6 bleeds/1000 person years v high, 40.3 bleeds/1000 person years; number needed to harm 85). CONCLUSIONS: After age or previous upper gastrointestinal bleeding were controlled for, antidepressants with high inhibition of serotonin reuptake increased the risk of upper gastrointestinal bleeding. These increases are clinically important for elderly patients and those with previous gastrointestinal bleeding.
ISSN:0959-8146