New Study Finds Taking NSAID Painkillers and Antidepressants Together Increase the Risk of Intracranial Bleeding

A new study published in The BMJ shows that, when taken together, nonsteroidal anti-inflammatory drugs (NSAID) painkillers and antidepressant drugs increase the risk of intracranial bleeding.

Pain is a symptom of depression, so many patients take antidepressants with pain medications such as ibuprofen and naproxen. The study focused primarily on prescription drugs, but the results could have wide implications for over-the-counter (OTC) NSAIDs, as well, according to Forbes.

For the study, researchers from Seoul National University College of Medicine analyzed data from over four million people who had started taking antidepressants between 2009 and 2013. About half of those patients were prescribed an NSAID. Using hospital records, the team looked to see who was admitted for intracranial bleeding in the 30 days after being prescribed the NSAID, Forbes reports.

The scientists found that individuals who began taking both medications had a 60 percent higher risk of intracranial bleeding than those taking only antidepressants. No difference in risk was found among the different types of antidepressants (SSRIs, SNRIs and tricyclics.) Men who took both antidepressants and NSAIDs were found to have a greater risk of bleeding around the brain than women. Their risk was approximately 2.6 times higher than men who took antidepressants alone, whereas the risk for women was 1.2 times higher than woman who just took one medication, according to Forbes.

The team only looked at bleeding that occurred during the first 30 days of the NSAID prescription, which could mean the long-term risk could be different or even higher. Each medication was found to have an inhibitory effect on platelets, and each is thought to increase the risk of bleeding on its own, though researchers aren’t certain why. Neither type of drug is known to raise the risk of intracranial bleeding on its own, Forbes reports.

The publication of the study comes days after the U.S. Food and Drug Administration (FDA) warned about the risk of heart attack and stroke from the use of NSAIDs. The agency said heart attack or stroke could occur within weeks of starting the medication, but the risk is higher in the long-term. NSAIDs and SSRI antidepressants are also linked with gastrointestinal bleeding, according to Forbes.

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