People who use antidepressants with non-steroidal anti-inflammatory drugs are at a raised risk of bleeding in the skull, researchers warn today.
A team led by Dr Byung-Joo Park at Seoul National University College of Medicine, Korea, examined the risk, as many patients take this combination of medications.
They write in The BMJ that: "Antidepressants can help depressive patients effectively, but concern exists that antidepressants may interact unfavourably with non-steroidal anti-inflammatory drugs (NSAIDs)."
This is because antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), and NSAIDs are each thought to increase the risk of abnormal bleeding.
The team carried out a study using nationwide health insurance figures for Korea, including information from 4,145,226 people. They found that the risk of intracranial haemorrhage was 60% higher for combined use of antidepressants and NSAIDs than for use of antidepressants without NSAIDs. But the type of antidepressant taken appeared to make no difference to the risk level.
In an editorial, Professor Stewart Mercer of Glasgow University, UK, and colleagues say the results "give some cause for concern".
In England, almost 40 million antidepressant prescriptions were issued in 2012, they point out. NSAIDs are also widely used, often without prescription and in non-pharmacy settings.
"Doctors often fail to consider the risks and potential interactions posed by non-prescribed drugs," they write. "Although NSAIDs bought over the counter are often taken for a short period only, this study reported elevated bleeding risk within 30 days of a new prescription."
Worryingly, they add, conditions requiring NSAIDs and antidepressants commonly coexist – 65% of adults with major depression also have chronic pain.
"Further research is needed to extend the findings over longer time periods and to quantify risks in different populations," they conclude.
The UK Royal College of GP said patients concerned by the findings should "not panic" but could make an appointment with their doctor.
Dr Liz England, from the college, said: “Most evidence until now suggests that antidepressants are a safe drug for most patients, but this paper highlights the need for caution especially when they’re being prescribed alongside other drugs.
"It is also important that as new research is published, we take this on board and guidelines for healthcare professionals are updated accordingly."
Shin, J-Y. et al. Risk of intracranial haemorrhage in antidepressant users with concurrent use of non-steroidal anti-inflammatory drugs: nationwide propensity score matched study. BMJ 15 July 2015 doi: 10.1136/bmj.h3517 [abstract]
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