Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal bleeding: a systematic review and meta-analysis.
Open accessAbstract
Background & aims Selective serotonin reuptake inhibitors (SSRIs) are used to treat various psychiatric disorders. However, there are concerns that SSRIs increase the risk for upper gastrointestinal bleeding (UGIB).Methods We performed a systematic review and meta-analysis of controlled observational studies to determine whether SSRI use affects the risk for UGIB. Our analysis included all observational studies that compared UGIB development among patients receiving SSRIs vs no treatment. We calculated pooled odds ratios using random- and fixed-effects models.Results A total of 22 studies (6 cohort and 16 case-control studies) involving more than 1,073,000 individuals were included in our meta-analysis. In comparing SSRI users with patients who had not taken SSRIs, the odds for developing UGIB were 1.55-fold higher (odds ratio, 1.55; 95% confidence interval, 1.35-1.78). In subgroup analyses, the association was greatest for patients who received concurrent therapy with nonsteroidal anti-inflammatory or antiplatelet drugs; we found no significant increase in the risk of developing UGIB among patients receiving concurrent acid-suppressing drugs.Conclusions SSRI use was associated with an almost 2-fold increase in the risk of developing UGIB, especially among patients at high risk for GI bleeding (concurrent use of nonsteroidal anti-inflammatory or antiplatelet drugs). This risk might be reduced significantly by concomitant use of acid-suppressing drugs.
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In a sensitivity analysis of class I or II evidence, the random-effects risk ratio for upper GI bleeding with SSRI plus other non-antidepressant use versus no SSRI use was 1.39 (95% CI, 1.21-1.61), based on 7 studies, with class II/Moderate evidence.
“RR: 1.39 | (1.21 to 1.61)”
From Association of Antidepressant Use With Adverse Health Outcomes: A Systematic Umbrella Review (2019) · cites this paper as Jiang et al, 64 2015
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- Authors
- Jiang, H.-Y., Chen, H.-Z., Hu, X.-J., Yu, Z.-H., Yang, W., Deng, M., Zhang, Y.-H., & Ruan, B.
- Affiliations
- First Affiliated Hospital Zhejiang University (CN)
- Corresponding author
- Ruan, Bing
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2015-01
- Volume
- 13
- Issue
- 1
- Pages
- 42-50.e3
- ISSN
- 1542-3565 (ISSN-L)
- OpenAlex
- W2021508018
- Cited by
- 213
- References
- 44
- Citations by year
- 2026: 16 · 2025: 13 · 2024: 27 · 2023: 18 · 2022: 12 · 2021: 13 · 2020: 15 · 2019: 21 · 2018: 16 · 2017: 26 · 2016: 22 · 2015: 7 · 2014: 5 · 2013: 1
- FWCI
- 3.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Fundamental Research Funds for the Central Universities (2014XZZX008)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Helicobacter pylori-related gastroenterology studies
- Health Sciences › Medicine › Pharmacology › Inflammatory mediators and NSAID effects
- Keywords
- selective serotonin reuptake inhibitors, upper gastrointestinal bleeding, drug-induced bleeding, nonsteroidal anti-inflammatory drugs, antiplatelet agents, acid suppressants, concomitant drug use
- MeSH terms
- Mental Disorders, Gastrointestinal Hemorrhage, Humans, Selective Serotonin Reuptake Inhibitors, Risk Assessment
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