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Selective Serotonin Reuptake Inhibitors Reduce Colorectal Cancer Risk, and the Effect Is Additive to Aspirin

Douglas K. Rex, MD, MASGE, reviewing Zhang N, et al. Am J Gastroenterol 2021 Feb 26.

In a nationwide Swedish registry study, 24,786 colorectal cancer (CRC) cases and 74,358 randomly matched controls for birth year and sex were evaluated to determine whether monotherapy or combined selective serotonin reuptake inhibitor (SSRI) and aspirin use reduce CRC risk. 

Aspirin monotherapy was associated with a 9% reduction in CRC risk, and SSRI use was associated with a 7% reduction. Evaluation of combined aspirin and SSRI users showed that combined therapy produced a 23% reduction in CRC risk, and the effects were additive, not synergistic. 

Of 5 individual SSRIs evaluated, the clearest benefits occurred with sertraline and citalopram.

Douglas K. Rex, MD, FASGE


These data indicate a chemopreventive effect for SSRIs or certain SSRIs, with an additive effect to aspirin. There appear to be benefits regardless of dose combinations (high- vs low-dose aspirin and high- vs low-dose SSRIs).

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Zhang N, Sundquist J, Sundquist K, Zhang ZG, Ji J. Combined use of aspirin and selective serotonin reuptake inhibitors is associated with lower risk of colorectal cancer: a nested case-control study. Am J Gastroenterol 2021 Feb 26. (Epub ahead of print) (

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