Commonly used NSAIDs include ibuprofen and aspirin.
Based on the ongoing concern of a drug interaction, a team of researchers based in Korea compared the risk of bleeding among patients treated with antidepressants with and without NSAIDs.
Using the Korean nationwide health insurance database, their study involved over four million people who were prescribed antidepressants for the first time between 2009 and 2013.
The researchers analyzed the timing of both NSAID prescriptions and hospital records to identify any patients with a first admission of intracranial haemorrhage within 30 days of a new prescription. Factors that could affect the results, such as age, sex, and use of other medications, were taken into account.
Compared with the use of antidepressants alone, the findings showed that a combined use of antidepressants and NSAIDs was linked to a significantly increased risk of bleeding.
They found no statistically meaningful differences in risk of bleeding between different types of antidepressant drugs, or with age. Being male, however, was the most common factor for a higher risk of bleeding with combined use of antidepressants and NSAIDs.
"The addition of NSAIDs to antidepressant treatment increased the risk of intracranial haemorrhage within 30 days of the combination starting, especially in men," conclude the authors. "This result adds to evidence confirming the increase of risk with combination use of antidepressants and NSAIDs."
In an accompanying editorial, Dr. Stewart Mercer at the University of Glasgow, and colleagues at the University of Cambridge, said the results give some cause for concern.
They point out that both types of drugs are widely used, and that co-morbidity of the conditions for which they are used is very high, as 65 percent of people with major depression also have chronic pain.
They urge family doctors to be extra vigilant in terms of writing prescriptions and discussing the risks with patients, especially in deprived areas where "the combination of mental and physical problems (including chronic pain) is very common."
The researchers say that although their findings may have been affected by other unmeasured or unknown factors, they believe that special attention is needed when patients use both types of drugs together. Further research is needed to extend the findings over longer time periods and in differing populations.
Comment: NSAIDs such as aspirin and ibuprofen are associated with stomach bleeding and also cause the body to retain fluids, which may lead to kidney damage. They also increase the risk of heart attack and stroke. Ibuprofen has been linked to dozens of adverse health effects, including anemia, DNA damage, hearing loss, hypertension, and miscarriage.