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Risk of intracranial haemorrhage linked to co-treatment with antidepressants and NSAIDs

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3745 (Published 14 July 2015) Cite this as: BMJ 2015;351:h3745

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Re: Risk of intracranial haemorrhage linked to co-treatment with antidepressants and NSAIDs

Antidepressants and polypharmacy

Polypharmacy for the elderly is rapidly becoming a scandal. The story of my husband's problems with unnecessary statins and beta-blockers after a stroke has already been told. (1) But his experience is by no means unique. It is probably easier for doctors to prescribe antidepressants than to refer patients for talking therapy, but this must be considered. Also, to include stroke patients in a trial involving antidepressants when they are not even depressed, and will certainly be on other medication, would seem to be bizarre. (2) Such patients require as few medications as possible, to avoid a multiplicity of adverse events, and in the case of stroke the risk of intracranial haemorrhage is certainly to be avoided. It is interesting to note that in the trial referred to here, 'Patients who had been diagnosed as having cerebrovascular diseases within a year before the index date were excluded.' (3) As the British National Formulary advises, in its prefatory remarks on prescribing for the elderly, 'elderly patients' medicines should be reviewed regularly and medicines which are not of benefit should be stopped'. (4)

What elderly patients need more than anything else is human contact, to relieve their isolation. In Edinburgh they may live on the top floor of a tenement, where recently a deceased elderly patient was only discovered after three years, when a GP alerted the police. It should not have taken three years for this to happen. Voluntary agencies offering support to elderly people exist, but too often doctors either don't know about them or don't refer to them. We need more joined-up thinking and joint working between the NHS, Social Care, and voluntary organisations, and less prescription of drugs for the elderly. It might even save the NHS money, besides being better for patients.

Heather Goodare
Edinburgh Health Forum
hm.goodare@virgin.net

1. Goodare H. Discontinuing drug treatments (rapid response). BMJ 2014; 349:g7013.

2. Fluoxetine Or Control Under Supervision (FOCUS) trial: to establish the effect(s) of routine administration of Fluoxetine in patients with a recent stroke: ISRCTN83290762.

3. Byung-Joo Park et al. Risk of intracranial haemorrhage in antidepressant users with concurrent use of non-steroidal anti-inflammatory drugs: nationwide propensity score matched study. BMJ 2015; 351: h3517

4. Prescribing for the elderly. British National Formulary 60 (September 2010) p. 24.

Competing interests: No competing interests

17 July 2015
Heather M. Goodare
retired
Edinburgh Health Forum
Edinburgh EH3 9LL