Can Prozac increase risk of bleeding?
Q: I’ve been taking Prozac for the past two years. I recently read that Prozac may increase the risk of bleeding. I had a bleeding ulcer 10 years ago. Can I continue taking it?
A: The news about a possible relationship between Prozac (fluoxetine) and related antidepressants came from a study published in the Archives of General Psychiatry. Researchers looked at two groups of people. The groups were similar in their mix of age and gender. But one group of 1,300 people had bleeding in the stomach or upper intestine. The other group did not. Researchers found that people in the group with bleeding were more likely than those in the other group to take certain drugs for depression.
The particular depression drugs found to be associated with bleeding included selective serotonin reuptake inhibitors (SSRIs) and a related drug. SSRIs include fluoxetine (Prozac) and sertraline (Zoloft). The related drug is venlafaxine (Effexor).
Choose Nature Instead of Prozac for PMS and PMDD.
[...]There it was - PMDD is an essentially manufactured condition not recognized by the WHO yet approved by the FDA so that our doctors can write even more prescriptions for a dangerous and highly controversial drug known to cause suicide and uncontrolled violence. And those prescriptions are for a condition that Prozac is prohibited from being used for in Europe[...]
We need to be careful about reading too much into reports such as this one. An association between SSRIs and bleeding does not prove that these drugs cause bleeding. Other explanations are possible. For example, depressed people treated with SSRIs may have more factors that increase their risk for bleeding. These factors may be unrelated to antidepressants. In my view, this study does not dramatically change the balance of risk and benefit for most depressed people who might benefit from an SSRI or venlafaxine.
Prozac update.
[...]So far, side effects have been minimal, although I am feeling tired in the afternoons more. At the moment that’s ok - I can either have a caffeine overload on the days I’m at work, or have a nap (yay for being a student…), but that’s not really going to be possible when I’m (hopefully) working full time in about 2 months. Apparently Prozac side effects do decrease with time as your body gets used to it, so I’m well willing to give mine the next two months to find out, but if it doesn’t get any better I know I’ll have to make some hard choices.[...]
Not all cases of stomach and intestinal bleeding can be prevented. You can, however, lower your risk by taking these steps:
- Limit your use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin. Take the lowest effective dose for only as long as necessary.
- Moderate your alcohol intake.
- Don’t smoke.
- If testing shows that you are infected with the bacterium H. pylori, take the recommended antibiotics.
- If you take SSRIs or venlafaxine, talk to your doctor about the study. If these drugs have helped, there may be no need to change.
Head fake: How Prozac sent the science of depression in the wrong direction.
[...]Prozac is one of the most successful drugs of all time. Since its introduction as an antidepressant more than 20 years ago, Prozac has been prescribed to more than 54 million people around the world, and prevented untold amounts of suffering[...]
What if you have multiple factors that increase your risk of stomach or intestinal bleeding? It may be a good idea to take steps to lower your risk. You could reduce your NSAID dose or take an acid-suppressing medicine such as Prilosec. Or you and your doctor may decide to switch antidepressants.
Today’s column was written by Robert H. Shmerling, M.D., associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. For consumer health information, visit health.harvard.edu.
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