de Abajo et al35 (11,899) | Antidepressant users 1993-1997 | 1651 cases of upper GI bleeding; 248 cases of ulcer perforation matched to 10,000 controls by age, sex, and time | Increased risk of upper GI bleeding with SSRIs (RR, 2.9; 95% CI, 2.0-4.2) |
Van Walraven36 (317,824) | Antidepressant users aged ≥65 y 1992-1998 | Observation for the duration of the prescription or until patients were admitted for upper GI bleeding | Overall bleeding rate of 7.3 per 1000 person-years; highest rates with older age, high inhibition of serotonin, and previous GI bleeding |
Tata et al37 (64,417) | Upper GI bleeding 1990-2003 | 11,261 cases and 53,156 controls matched for age and sex | Increased risk of GI bleeding with SSRIs (OR 2.38; 95% CI, 2.08-2.72); higher risk with concurrent NSAIDs |
Dalton et al6 (26,005) | Antidepressant users 1991-1995 | Observation from first prescription to first hospital admission for GI bleeding | Rate of GI bleeding for SSRI users is 3.1 per 1000 treatment y; increased risk with concomitant NSAID or aspirin |
Lewis et al38 (2248) | Upper GI bleeding | 359 cases matched to 1889 controls | Moderate - or high-affinity SSRI increased odds of hospitalization (OR, 2.0; 95% CI, 1.4-3.0); higher odds with concomitant high-dose NSAIDs (OR, 3.5; 95% CI, 1.9-6.6) |
Dall et al39 (40,154) | Peptic ulcer diagnosis 1995-2006 | 3652 cases of GI bleeding and 36,502 controls matched for age and sex | Adjusted OR, 1.67 (95% CI, 1.46-1.92) for current SSRI users; adjusted OR, 0.96 (95% CI, 0.50-1.82) among PPI users |
Schelleman et al40 (666,235) | Warfarin users 1999-2005 | 13,026 cases of GI bleeding and 653,209 controls matched for index date and state | Increased OR upon initiation of citalopram, fluoxetine, paroxetine, amitriptyline, and mirtazapine |
Castro et al41 (36,389) | Antidepressant users 1990-2009 | Exposure period of initial prescription to end of a continuous documented period of exposure | Adjusted RR, 1.17 (95% CI, 1.02-1.34) for antidepressants with high affinity for serotonin transporters |