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Dysfagia and gastroesophageal reflux disease (GERD): TCAs, by causing xerostomia (anticholinergic and antihistaminic effects) and inhibiting smooth muscle function, may contribute to dysphagia. Anticholinergic effects may also cause physiological impairment to the lower oesophageal sphincter resulting in or aggravating GERD. GI bleeding: AD with serotonergic action deplete platelet serotonin, leading to a reduced ability to form clots and a subsequent increase in the risk of bleeding. SSRIs and, with limited evidence, mirtazapine and bupropion, are associated with a similar GI bleeding risk, mostly of the upper GI tract. Microscopic colitis: May be iatrogenic -Nonsteroidal anti-inflammatory drug (NSAIDS) and SSRIs (particularly sertraline) most implicated.

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