Combining SSRIs and NSAIDs: Increased Risk of Bleeding

Research has shown that combining antidepressants and non-steroidal anti-inflammatory drugs (NSAIDs) increases the risk of intracranial hemorrhage, bleeding, and bruising.

Why is this?

According to a research article published in the American Journal of Medicine entitled “Effects of nonsteroidal anti-inflammatory therapy on platelets,” this increased risk of bleeding, bruising, and even hemorrhaging is because serotonin reuptake inhibitors (SSRIs) impair platelet function, and, so do NSAIDs.

Platelet function? What is that?

Platelets, or thrombocytes, are small, colorless cell fragments in our blood that form clots and stop or prevent bleeding.

NSAIDs are known to inhibit normal platelet function, as are SSRIs, therefore when combined, these two medications can cause bleeding and bruising.

Combining SNRIs with NSAIDs is also problematic.

At elevated levels, when SNRIs, which block the reuptake of norepinephrine, are combined with NSAIDs, this combination can also lead to an increased risk of intracranial hemorrhages.

According to research, SSRIs and SNRIs alone have been not been associated with an increased risk of intracranial hemorrhage. However, questions still remain about bleeding risks when either drug is used in combination with NSAIDs, as well as which dosages establish a greater risk.

Combining SSRIs and NSAIDs can also increase the risk of adverse gastrointestinal effects.

But that’s not all.

Not only can combining SSRIs with NSAIDs lead to bleeding, bruising, and gastrointestinal issues, but according to research published in the Harvard Mental Health Letter, the combination may make selective serotonin reuptake inhibitors and SNRIs less effective.

Researchers analyzed the results of the “Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study”, which was a large examination of depression treatments. The study found that only 45% of STAR*D participants who took an SSRI along with a pain medication achieved complete relief of depression symptoms, while 55% of people who were taking an SSRI alone (without pain medication) did so.

Does this mean that pain-relieving over-the-counter medications can never be taken by those of us currently taking SSRIs or SNRIs?

Not necessarily.

Some studies suggest that acetaminophen, commonly sold under the brand name Tylenol, is a safer alternative to NSAIDs in combination with SSRIs. However, it’s always best to first consult with your doctor or pharmacist before taking any type of pain medicine.

By consulting a medical expert or pharmacist before taking another medicine with an SSRI or SNRI, you can do your part to ensure the safest possible outcome in treating both your depression and your pain.

In our next article, we will look at the risks of combining other psychiatric medications with NSAIDs such as anti-anxiety, antipsychotics, and more.

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