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Combined use of antidepressants, NSAIDs increases risk for intracranial hemorrhage

Results from a retrospective, nationwide, propensity score matched cohort study indicate higher risk for intracranial hemorrhage among individuals, particularly males, prescribed antidepressants and nonsteroidal anti-inflammatory drugs, compared with those prescribed antidepressants only.

“Depression produces the greatest decrement in health of all common chronic conditions, and depression in older people is an important public health problem. Antidepressants can help depressive patients effectively, but concern exists that antidepressants may interact unfavorably with nonsteroidal anti-inflammatory drugs (NSAIDs),” study researcher Ju-Young Shin, PhD, of the Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea, and colleagues wrote.

Using the Korean Health Insurance Review and Assessment Service Database, researchers reviewed claims data for 4,145,226 patients prescribed antidepressants from January 2009 through December 2013. Of these, 2,072,613 were also prescribed NSAIDs at some point during the study period.

Individuals prescribed antidepressants and NSAIDs had a higher risk for intracranial hemorrhage compared with those prescribed antidepressants only (HR = 1.6; 95% CI, 1.32-1.85). This risk was higher among males (HR = 2.6; 95% CI, 1.93-3.42) vs. females (HR = 1.2; 95% CI, 0.89-1.57).

Risk for intracranial hemorrhage did not significantly differ between antidepressant classes, and comorbidities and use of other medications did not increase risk for intracranial hemorrhage with combined use of antidepressants and NSAIDs, according to researchers.

“The addition of NSAIDs to antidepressant treatment increased the risk of intracranial hemorrhage within 30 days of the combination starting, especially in men,” Shin and colleagues wrote. “This result adds to evidence confirming the increase of risk with combination use of antidepressants and NSAIDs. Special attention is needed when patients use both these drugs together.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.