- Elderly people and those with a history of bleeding disorders
have been warned of the risk of taking certain types of anti-depressants.
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- Experts say a group of anti-depressants called selective
serotonin re-uptake inhibitors or SSRIs may predispose some people to internal
bleeding.
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- Writing in the Drug and Therapeutic Bulletin, they said
the drugs should not be given to 'at risk' groups.
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- The Department of Health said clearer warnings were being
considered.
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- Over 12 million prescriptions for SSRIs are written each
year. Around four million of these are given to elderly people.
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- Research review
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- Researchers from the Consumer's Association reviewed
three studies where patients had taken SSRIs.
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- One study of 12,000 people in the UK found that those
who suffered gastrointestinal bleeding were three times more likely to
have been prescribed SSRIs during the previous 30 days, compared to other
patients.
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- The risks were even greater for those who took aspirin
along with SSRIs. They were seven times more likely to have suffered gastrointestinal
bleeding.
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- The researchers analysed the findings from another study
of 300,000 people in Canada. All of those who took part in the study were
over the age of 65 and all were taking anti-depressants.
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- The researchers divided the study participants into those
who were taking SSRIs and those on other anti-depressants.
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- They found that those on SSRIs had a slightly higher
risk of gastrointestinal bleeding compared to others.
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- The risks were greatest for patients over the age of
80. They were almost 50% more likely to suffer gastrointestinal bleeding
if they were taking SSRIs compared to other patients.
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- The researchers said doctors should avoid prescribing
SSRIs to people in 'at risk' groups.
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- "On current evidence, we suggest that SSRIs should
be avoided if possible, or used with caution, in patients aged over 80
years, those with prior upper gastrointestinal bleeding or in those also
taking aspirin or another NSAID," they wrote.
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- Joe Collier, editor of the Drug and Therapeutic Bulletin,
said the risks of bleeding were small.
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- "While the overall risk of gastrointestinal bleeding
due to use of SSRIs is small, this risk is significantly increased among
older patients or those with a history of gastrointestinal bleeding,"
he said.
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- "The best course of action, therefore, would be
to limit use of these anti-depressants in 'at risk' patients."
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- A spokesman for the Department of Health said current
warnings could be strengthened.
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- "Product information for all SSRIs already contains
warnings about the possible increased risk of bleeding, including gastrointestinal
bleeding, and advises caution when used in combination with other drugs
that cause bleeding, such as NSAIDs.
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- "Strengthened warnings about the risk of gastrointestinal
bleeding are being considered by the SSRI Expert Working Group."
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- Last December, doctors were told not to prescribe the
majority of SSRIs to children amid fears they could make young people suicidal.
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- The Medicines and Healthcare products Regulatory Agency
studied the latest evidence on these drugs.
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- They concluded that the risks outweighed the benefits
and said SSRIs should not be given to under 18s.
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- © BBC MMIV
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- http://news.bbc.co.uk/2/hi/health/3526703.stm
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