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PAPERS: C van Walraven, M M Mamdani, P S Wells, and J I Williams Inhibition of serotonin reuptake by antidepressants and upper gastrointestinal bleeding in elderly patients: retrospective cohort study BMJ 2001; 323: 655 [Abstract] [Full text]

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Lisa Lytle   (5 October 2001)

Antidepressants and GI bleeding

Charles Campion-Smith   (17 October 2001)

Re: Antidepressants and GI bleeding

Jay R Hodes   (20 November 2001)

Error 5 October 2001
Lisa Lytle, Editor eMIMS, Haymarket Medical Send response to journal: Re: Error	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
Antidepressants and GI bleeding 17 October 2001
Charles Campion-Smith, GP / Primary Care Educator 15 Cornwall Road, Dorchester, Dorset Send response to journal: Re: Antidepressants and GI bleeding	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
Re: Antidepressants and GI bleeding 20 November 2001
Jay R Hodes, Clinical Faculty,Ret. UCLA School of Medicine 4261 Cedros Ave Sherman Oaks, CA 91403 Send response to journal: Re: 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.?