Authors response

Sir,

We thank Tasci et al. for their interest and thoughtful comments regarding our recently published study, which shows that depression and anxiety are common comorbidities in gastroenterological outpatient population, especially those who have a chronic course of multiple gastrointestinal complaints.[1] We acknowledge that our study did not look at biological markers that may add to the growing body of literature emphasizing gut as a second brain.[2] Recent neurobiological findings showed that a complex, bidirectional communication system occurs via neural, immunological, and hormonal routes that not only ensures the proper maintenance of gastrointestinal homeostasis and digestion but is likely to have multiple effects on affect, motivation, and higher cognitive functions, including intuitive decision making. Furthermore, derangement of the gut–brain system has been implicated in many disorders, including functional and inflammatory gastrointestinal disorders, obesity, and eating disorders.[3]

Finally, we like to share with our readers recent, reassuring data about the debatable association of the widely used antidepressants; selective serotonin reuptake inhibtors (SSRIs), and upper gastrointestinal bleeding (UGIB). One meta-analysis showed that the number needed to harm in a low-risk population was 3177, and in a high-risk population it was 881. The risk of UGIB was further increased with the use of both SSRI and nonsteroidal anti-inflammatory drug medications (odds ratio = 4.25, 95% confidence interval = 2.82, 6.42).[4] The second meta-analysis showed similar results. Moreover, it found no significant increase in the risk of developing UGIB among patients receiving concurrent acid-suppressing drugs.[5]