When drug treatments collide, patients suffer

Double Jeopardy

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 seven years ago, elderly patients are most vulnerable to this risk.

Nowimagine what happens when nonsteroidal anti-inflammatory drugs (NSAIDs) are added to the mix.

Not good.

When treatments collide

In a meta-analysis reported late last year, Northwestern University researchers gathered data from four studies and found that SSRI use was twice as likely to cause 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 took neither medication.

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.

A new study reported this month in the Archives of General Psychiatry produced results similar to the Northwestern study.

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.

But this study added an interesting wrinkle. Patients who used NSAIDs and SSRIs but didn’t use acid-suppressing agents were at NINE times greater risk compared to people who didn’t use those drugs. In their conclusions the authors write: “Use of acid- suppressing agents limits such increased risk.”

Ready for the kicker? The study was sponsored by AstraZeneca, the drug company that makes Nexium and Prilosec – two top selling acid-suppressing agents.

Gee – thanks for enlightening us, AZ! But before adding ANOTHER drug to an already disastrous cocktail, this would be an excellent time to address the key issues that are really at work here. (Hint: We’re not talking about a Prozac deficiency or an NSAID deficiency.)

Inflammation nation

For any patients – no matter their age – who are faced with the dual problems of depression and arthritis pain, I have three words: 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:
“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
“The Impact of Prevention on Reducing the Burden of Cardiovascular Disease” Circulation, Published online 7/7/08, circ.ahajournals.org