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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

Rapid Response:

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

The authors are correct that there is a high degree of comorbidity between depression and chronic pain but they overlook another important point about the combined use of antidepressants and NSAIDS.

The SNRI antidepressants also have analgesic properties separate from their antidepressant effects. They are considered first line drugs for many common forms of chronic pain including neuropathic pain and fibromyalgia. and can be beneficial for many other forms of chronic pain including low back and arthritic pain. These patients may also be taking NSAIDS for the pain making the results of the study very relevant even for those who are not being treated for depression.

Competing interests: No competing interests

21 July 2015
Steven A King
Physician specializing in pain management
New York, NY, USA