Kyoung-Sae Na1, Han-Yong Jung2, Seong-Jin Cho3, Seo-Eun Cho4. 1. Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Republic of Korea. 2. Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea. 3. Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Republic of Korea. Electronic address: sjcho@gilhospital.com. 4. Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Republic of Korea. Electronic address: arztin01@hanmail.net.
Abstract
BACKGROUND: Many studies have reported that selective serotonin reuptake inhibitors (SSRI) are associated with an increased risk of bleeding. Mirtazapine and bupropion, which commonly lack serotonin reuptake inhibition, have been recommended as alternatives for patients who are at risk for bleeding. However, the evidence for these recommendations is insufficient. METHODS: We conducted a systematic search, systematic review, and meta-analysis to investigate an evidence-based approach for the bleeding risks of mirtazapine and bupropion. From 1946 to May 2017, a total of 3981 studies were searched from PubMed, Embase, and the Cochrane Library. Among the studies, two independent reviewers selected studies per predefined eligibility criteria. RESULTS: A total of five meta-analyses were conducted. Patients taking mirtazapine were at a greater risk of gastrointestinal bleeding (OR = 1.17, 95% CI = 1.01-1.38) than those who did not take antidepressants. No differences were observed in the bleeding risk between mirtazapine and SSRI or between bupropion and SSRI. LIMITATIONS: The number of studies included in the meta-analysis was small. CONCLUSION: Our results suggest that it is premature to recommend mirtazapine and bupropion for patients who have a bleeding risk. More studies with larger sample sizes and longitudinal follow-ups are warranted.
BACKGROUND: Many studies have reported that selective serotonin reuptake inhibitors (SSRI) are associated with an increased risk of bleeding. Mirtazapine and bupropion, which commonly lack serotonin reuptake inhibition, have been recommended as alternatives for patients who are at risk for bleeding. However, the evidence for these recommendations is insufficient. METHODS: We conducted a systematic search, systematic review, and meta-analysis to investigate an evidence-based approach for the bleeding risks of mirtazapine and bupropion. From 1946 to May 2017, a total of 3981 studies were searched from PubMed, Embase, and the Cochrane Library. Among the studies, two independent reviewers selected studies per predefined eligibility criteria. RESULTS: A total of five meta-analyses were conducted. Patients taking mirtazapine were at a greater risk of gastrointestinal bleeding (OR = 1.17, 95% CI = 1.01-1.38) than those who did not take antidepressants. No differences were observed in the bleeding risk between mirtazapine and SSRI or between bupropion and SSRI. LIMITATIONS: The number of studies included in the meta-analysis was small. CONCLUSION: Our results suggest that it is premature to recommend mirtazapine and bupropion for patients who have a bleeding risk. More studies with larger sample sizes and longitudinal follow-ups are warranted.
Authors: Elena Dragioti; Marco Solmi; Angela Favaro; Paolo Fusar-Poli; Paola Dazzan; Trevor Thompson; Brendon Stubbs; Joseph Firth; Michele Fornaro; Dimitrios Tsartsalis; Andre F Carvalho; Eduard Vieta; Philip McGuire; Allan H Young; Jae Il Shin; Christoph U Correll; Evangelos Evangelou Journal: JAMA Psychiatry Date: 2019-12-01 Impact factor: 21.596