Antidepressant-mediated gastroesophageal reflux disease

Area of Science:

• Pharmacology
• Gastroenterology
• Psychiatry

Background:

• Anticholinergic effects of medications can impact lower esophageal sphincter function, potentially leading to gastroesophageal reflux disease (GERD).
• GERD affects up to 25% of adults and is a consideration in depression treatment, a significant disease burden.
• Tricyclic antidepressants are known to affect lower esophageal sphincter function, but newer agents like SSRIs and SNRIs are now common first-line treatments.

Observation:

• A case report details a 55-year-old woman experiencing nausea and gastric reflux while on citalopram and escitalopram for depression.
• These symptoms persisted despite dose adjustments and positioning changes.
• The patient was eventually managed with desvenlafaxine and scheduled omeprazole for GERD.

Findings:

• The Naranjo Adverse Drug Reaction Probability Scale indicated a probable link between antidepressant therapy and GERD symptoms (score of 7/12).
• Selective serotonin-reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) may contribute to GERD development.
• This case highlights the potential for newer antidepressants to cause anticholinergic-related side effects.

Implications:

• Clinicians should inquire about new-onset symptoms, including nausea and gastric reflux, when patients start new antidepressant medications.
• Monitoring for potential medication-related effects, such as anticholinergic profiles, is crucial.
• This assessment may guide decisions on adding antisecretory agents or considering alternative treatments for depression.