When two best selling drugs are combined, results can be disastrous

Bad Mix

Next time you’re at a crowded mall, or a busy outdoor fair, or a packed concert venue, look around and consider this: About one of every ten of those people take an antidepressant drug.

That’s staggering.

According to a recent report, the number of Americans on antidepressants (about 27 million) has doubled over the past decade. And what’s worse: Many of those people aren’t even treating depression. As many as HALF of them may have been prescribed antidepressants to relieve insomnia, fatigue, back pain, and nerve pain.

Patients in those last two groups need to be very careful. If they’re in pain, they’re likely also taking non-steroidal anti-inflammatory drugs (NSAIDs). And if they’re taking NSAIDs and antidepressants daily, they may be doing irreparable harm to their upper gastrointestinal tracts.

Collision course

In addition to a long list of other side effects, your risk of upper gastrointestinal bleeding increases with the use of antidepressants – specifically, selective serotonin reuptake inhibitors (SSRIs) like Prozac. And as I first noted in an e-Alert several years ago, elderly patients are most vulnerable to this risk.

Now imagine what happens when NSAIDs are added to the mix.

In a 2008 meta-analysis, researchers gathered data from four studies and found that SSRI use sharply increased risk of bleeding in the upper gastrointestinal tract (esophagus, stomach, and upper small intestine). Results also showed that when SSRIs were combined with NSAIDs, upper gastrointestinal bleeding was SIX times more likely compared to subjects who didn’t take either of the drugs.

A recent study in the Archives of General Psychiatry produced similar results.

Researchers at the Spanish Agency for Medicines and Healthcare Products collected drug use data from more than 1,300 patients with upper GI bleeding and about 10,000 healthy control subjects. Patients who combined SSRIs and NSAIDs were nearly five times more likely to develop GI bleeding compared to subjects who didn’t use the drugs.

These results are particularly worrying for elderly patients. When these SSRIs and NSAIDs are combined (and they often are among the elderly), bleeding in the gastrointestinal tract contributes to anemia – a gateway to numerous health problems.

Inflammation nation

Any patients – no matter their age – who are faced with the dual problems of depression and arthritis pain, might find relief with cod liver oil.

In the e-Alert “Tremors & Aftershocks” (10/18/04), I told you about research that shows how cod liver oil may reverse the actions of the enzymes that break down cartilage. In fact, studies suggest that taking cod liver oil might even prevent the development of arthritis.

And in the e-Alert “There Will Be Oil” (4/9/08), HSI Panelist Allan Spreen, M.D., had this to say, regarding a cod liver oil dosage of 10 grams daily: “Similar doses can be used on depression, bipolar disorder, high triglycerides, and other issues tied to inflammation besides arthritis. But it also requires (in my opinion) 400 iu of vitamin E mixed tocopherols twice/day, to stop the free radical formation that comes from even the ‘good’ polyunsaturated oils.”

And as I’ve noted in previous e-Alerts, there are several other nutrients that help keep depression in check. For instance, high levels of B vitamins (which include folate, a proven depression-fighter), magnesium, and omega-3 fatty acids have all been shown to help reduce symptoms of depression.

Dr. Spreen cautions that a high intake of cod liver oil may cause stomach upset in some patients, so a therapeutic dose may need to be adjusted – ideally under the guidance of a health care professional with a background in nutrition.

Sources:
“Number of Americans Taking Antidepressants Doubles” Liz Szabo, USA Today, 8/3/09, usatoday.com
“Meta-Analysis: Gastrointestinal Bleeding due to Interaction Between Selective Serotonin Uptake Inhibitors and Non-Steroidal Anti-Inflammatory Drugs” Alimentary Pharmacology & Therapeutics, Vol. 27, No. 1, January 2008, wiley.com
“Risk of Upper Gastrointestinal Tract Bleeding Associated with Selective Serotonin Reuptake Inhibitors and Venlafaxine therapy” Archives of General Psychiatry, Vol. 65, No. 7, July 2008, archpsyc.ama-assn.org