Is the combined use of antidepressants and pain killers risky? Well, the answer may well surprise you. According to new research there is an increased risk of brain hemorrhage when painkillers like ibuprofen and antidepressant medicines are used together. With the increased use of pain killers and antidepressants, it seems there is really something that we need to be worried about. Dr. Rupert Payne from the Cambridge Centre for Health Services Research delves deeper into the evidence.
Popping in those pain killer pills to get relief from headache, or to soften those sore joints is fairly common. We often take these pills to reduce the symptoms of common cold. Some of these drugs commonly used by people like ibuprofen belong to a class of drugs called NSAIDS – non-steroidal anti-inflammatory drugs. The use of these medicines is widespread; in fact, they are amongst the top-twenty most frequently prescribed medications in UK primary care. Many of these medicines are non-prescription and can easily be bought from supermarket shelves where there is no pharmacists to keep a check on it.
Similarly, antidepressants are also commonly used in the UK; although these medicines are prescription only. One interesting thing to note here is that often depression and chronic pain co-exist in people. By a rough estimate a third of those suffering from a painful condition also experience depression, and over a quarter of those suffering depression also report of having chronic pain.
A recent study published in British Medical Journal has identified that there in an increase in the risk of brain hemorrhage when antidepressants and NSAIDS are used together. That surely raises concerns but the question remains is that really so straightforward?
It is already known that combined used of antidepressants and NSAIDS can cause gastrointestinal bleeding this already established risk is likely greater than the newly identified risk of brain haemorrhage. Despite that many GPs remain unaware of this problem, and their prescribing behaviour is not influenced by this study.
One point which must be taken into account is the fact that the risk of brain haemorrhage is relatively low: if both antidepressants and NSAIDS are taken daily for a period of 30 days, only one person in every 2,000 would be likely affected. Again, the absolute benefits of antidepressants and NSAIDs cannot be easily quantified, and are typically assessed in the context of the individual’s personal psychological and social circumstances. So, it is very difficult to find out the balance of harm and benefits.
If antidepressants and NSAIDs cannot be prescribed together, then doctors will understandably ask for alternatives. And the bad news is there are only limited options left. The crux of the matter is patients’ quality of life will be significantly diminished by stopping these medicines.
These are several other important questions which this recent study doesn't answer.
What are the longer-term risks? Are the risks same when the drugs are used separately? Can these findings be generalized when the study is based on an East-Asian population? Of course, there is a need for further research before concluding the risks. This new paper does identify a potential small risk of adverse consequences of combining two common drugs, but several queries still remain unresolved. If you are one among those who is prescribed both of these medicines, do discuss your concerns with your doctor.
Nevertheless, the issues raised by this study are important and quite relevant to safe and rational use of medicines. It is not uncommon for a person to be suffering from more than one ailment- so they may need to take a combination of drugs. So, further research to understand the challenges associated with using combinations of medicines in people with multiple health conditions is much needed.
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