Key points:
INTRODUCTION
Depression is common in older adults. The prevalence rates of depressive symptom in population aged ≥65 years vary widely across countries, ranging from 7.2% to 49%[1]. Depressed older individuals experience mood disturbance from multiple somatic complaints[2] and have significant mobility-related disabilities and poor prognosis[3, 4]. Therefore, appropriate intervention should be provided to these patients, and medical therapy with antidepressants is generally suggested.
Selective serotonin reuptake inhibitors (SSRIs) are preferred over other classes of antidepressants such as tricyclic antidepressants or monoamine oxidase inhibitors as they are equally effective and have lower side effects[5]. They are now prescribed as first-line treatment in older adults with depression[6]. However, the risk of upper gastrointestinal bleeding (UGIB) caused by SSRIs has gained much public attention because of its impact on platelet aggregation[7], which can lead to bleeding events[8].
Although several studies have consistently shown that SSRI use, their dosages, and duration of treatments are associated with risk of UGIB[8-17], these studies did not focus on older people[8, 9, 11, 13-17] and did not provide information about the risks associated with the doses of each individual drug[8, 15, 17]. Older people are more likely to have multiple chronic health conditions, tend to be treated with multiple medicine, and are possibly more vulnerable to adverse events associated with overtreatment[18, 19]. Furthermore, older age is significantly associated with increased mortality, especially in patients with UGIB, and co-morbidities along with concomitant medicine use can worsen the bleeding events[12, 13, 20]. Therefore, we aimed to evaluate the association between use of individual SSRI drugs and risk of UGIB, and quantify the risks associated with treatment doses.
METHODS