Inhibition of serotonin reuptake by antidepressants and upper gastrointestinal bleeding in elderly patients: retrospective cohort study
BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7314.655 (Published 22 September 2001) Cite this as: BMJ 2001;323:655All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Sir,
I read the BMJ for information, stimulation and entertainment. In the
first category I seek papers that may have implications for my everyday
practice and that on antidepressants and gastrointestinal bleeding
appeared to be one such.
I found the information interesting and probably relevant but have
been unable to review or modify my practice as I do not know the relative
strength of serotonin uptake inhaibition of the antidepressants I
prescribe. In fact I am not aware that there is a difference in potency at
the commonly used doses.
I accept that perhaps that this is something I should know, though I
could find no reference for scales of potency of serotonin uptake cited.
However in the meantime the usefulness of this paper to practising
doctors could be greatly enhanced by a table listing the differing
strength of serotonin uptake of the commonly used antidepressants.
Yours
Charles Campion-Smith MB ChB DCH FRCGP
Competing interests: No competing interests
Dear Sir/Madam
In the introduction of the article entitled 'Antidepressants as risk
factor for ischaemic heart disease: case-control study in primary care'the
authors state "Tricyclic antidepressants are not recommended in patients
with known ischaemic heart disease, mainly because of their arrhythmogenic
activity." This is obviously the case. However, in their conclusion the
authors suggest a possible explanation for the cardivascular effects of
TCADs and effectively state the opposite: "...tricyclic antidepressants
are class one antiarrhythmic drugs and can cause orthostatic hypotension.
Both of these effects can precipitate a myocardial infarction." First,
TCADs are not class one antiarrhythmics and second, a class one
antiarrhythmic is not an effect (as in "both of these effects") but a drug
class.
Should 'class one antiarrhythmic drugs' actually have said
'arrhythmogenic drugs'?
Lisa Lytle
MRPharmS
Competing interests: No competing interests
Re: Antidepressants and GI bleeding
If serotonin helps platelet aggregation, and its depletion in
platelets creates a greater GI bleeding propensity in elderly persons, why
would it not create the same in other parts of the body, e.g., increased
epidermal ecchymoses in response to mild blunt trauma, or hematuria, etc.?
Competing interests: No competing interests