Electronic Letters to:

Articles:
Lena Palaniyappan, Lisa Insole, and Nicol Ferrier
Combining antidepressants: a review of evidence
Adv Psychiatr Treat 2009; 15: 90-99 [Abstract] [Full text] [PDF]
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[Read eLetter] Antidepressants and bleeding.
Andrew Al-Adwani   (6 March 2009)

Antidepressants and bleeding. 6 March 2009
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Andrew Al-Adwani,
Consultant psychiatrist
Great Oaks , Ashby High Street,Ashby, North Li ncolnshire, DN16 2JX

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Re: Antidepressants and bleeding.

al-adwani{at}ntlworld.com Andrew Al-Adwani

In this useful article the side- effects of combination treatments neatly follow the description of each combination but none has included bleeding.

Abnormal bleeding with serotonin reuptake inhibitors (SRIs) has been studied and reviewed. One of the authors, has written on the subject (Paton and Ferrier,2006) and recommended caution when prescribing SRIs to patients at risk of gastrointestinal (GI) bleeds in particular.

The authors note that the best evidenced combination antidepressant treatment is an SRI plus either a noradrenergic specific serotonergic antidepressant or trazodone. Meijer, et al (2004) have demonstrated that degree of inhibition of serotonin reuptake is associated with risk of abnormal bleeding. Abajo, et al (1999) though found the highest association between antidepressant use and GI bleeds occurred with trazodone despite it being a weak SRI. It may be reasonable, therefore, to expect the combination of an SRI and trazodone, through differing mechanisms, to be associated with significant abnormal bleeding.

REFERENCES

Paton C and Ferrier IN. (2005) SSRIs and gastrointestinal bleeding. BMJ 331, 529-30.

Palaniyappan L., Insole L. and Ferrier N. (2009) Combining antidepressants: a review of evidence. Advances in Psychiatric Treatment, 15, 90-99.

Meijer W.E.E., Heerdink E.R., Nolen W.A., Herings R.M.C., Leufkens H.G.M., Egberts A.C.G. (2004) Association of risk of abnormal bleeding with degree of serotonin reuptake inhibition by antidepressants. Arch Intern Med, 164, 2367 - 2370.

de Abajo F.J., Rodríguez L.A.G., and Montero D. (1999) Association between selective serotonin reuptake inhibitors and upper gastrointestinal bleeding: population based case control study. BMJ, 319,1106-1109.