Taking a combination of antidepressants and common painkillers is associated with an increased risk of bleeding soon after starting treatment, according to a study from South Korea.
Writing in the British Medical Journal, the researchers suggested special attention was needed when patients used both classes of drugs together.
They compared the risk of bleeding among patients treated with antidepressants with and without non-steroidal anti-inflammatory drugs.
“The addition of NSAIDs to antidepressant treatment increased the risk of intracranial haemorrhage within 30 days”
They also noted that it was already “generally believed” that NSAIDs and antidepressants increased the risk of abnormal bleeding when used separately.
Their study involved over four million Korean people who were prescribed antidepressants for the first time during 2009-13.
NSAID prescriptions were obtained and hospital records were used to identify time to first admission with intracranial haemorrhage within 30 days of a new prescription.
Compared with use of antidepressants alone, the team found that combined use of antidepressants and NSAIDs was associated with a substantially increased bleeding risk.
They found no statistically meaningful differences in risk of bleeding between different types of antidepressant drugs, or with age. Being male was the most common factor for a higher risk of bleeding with combined use of antidepressants and NSAIDs.
The authors said: “The addition of NSAIDs to antidepressant treatment increased the risk of intracranial haemorrhage within 30 days of the combination starting, especially in men.
“This result adds to evidence confirming the increase of risk with combination use of antidepressants and NSAIDs,” they added.