Are Anti-Depressants Bad To The Bone?
Osteoporosis is a bone condition expected to increase in prevalence as our population pyramid shifts towards old age.
It is associated with decreased bone mineral density and an increased risk of fractures which may eventually cause a loss of mobility and independence as well as chronic pain.
Depression is another condition common in the elderly population. As such, mainstream medicine often relies on anti-depressant medications for the treatment of these individuals.
SSRIs or selective serotonin reuptake inhibitors are the most common anti-depressants prescribed in the Australian market.
Brand names you might recognise are Zoloft, Cipralex, Paxil, Prozac and Luvox.
Statistics show that there has been a 95% increase in the prescription of anti-depressants in general in Australia between 2000 and 2011. Australia is actually the second highest prescriber of anti-depressant medications globally!
How Are The Two Conditions Related?
Depression and osteoporosis may seem like unrelated conditions, however there is a growing body of evidence to suggest that there is a significant association between them, and an even stronger association between anti-depressant medications and osteoporosis.
People with depression have been found to have lower bone mineral densities than their non-depressed counterparts due to a number of lifestyle factors characteristic of depression.
These include spending more time indoors and therefore having lower vitamin D levels, increased likelihood of smoking and excess alcohol intake, less varied and nutrient depleted diets, concomitant medical conditions and medication use.
Physiologically depression is linked with hypogonadism, elevated cortisol (stress hormone) levels and specific immune cells which can promote inflammation and reduce bone density.
Depressed individuals are also believed to have lower levels of mood regulating neurotransmitters such as serotonin. Hence why they are treated with SSRIs – medications that target serotonin to prolong its activity in the central nervous system.
While serotonin plays an important role in nervous system health, most of the serotonin made in the body is in the gut and is involved in regulating gut motility.
Recently, research has revealed that bones also have serotonin receptors and transporters, indicating that serotonin may play a role in bone health too.
This raises the question of how SSRI medications which block serotonin re-uptake may affect bone health and metabolism.
The exact way in which SSRIs affect bone density has still not been conclusively determined. Some research shows it is due to an inhibiting effect of higher peripheral levels of serotonin on osteoblasts (bone forming cells).
In general it appears that the benefits of SSRIs in increasing central nervous system levels of serotonin for mood regulation are outweighed by the negative effects of increased peripheral serotonin levels on bone.
Confirming evidence from longitudinal and epidemiological studies shows that SSRI users have a greater decline in bone mineral density and increased risk of bone fractures – by up to twice as much compared to non-SSRI users.
Why SSRIs May Not Be Your Best Choice
Although we have looked at only depression in this article, SSRIs are a first line mainstream medical treatment for a wide range of other conditions such as post-traumatic stress disorder, generalised anxiety disorder, stress, panic disorders, premenstrual dysphoric disorder, chronic pain, fibromyalgia, post menopausal symptoms (eg. hot flushes, night sweats).
This means a huge percentage of the population, of all ages, is likely to be taking SSRIs right now and may therefore be at higher risk of poor bone health.
Post-menopausal women may experience problems with osteoporosis to the greatest degree, as their oestrogen levels have naturally declined reducing bone mineral density and thereby confounding the bone-loss effects of SSRI medications.
Additional concerns surrounding SSRIs is that their efficacy varies greatly from person to person. This may due to the fact that they do not address the underlying causes of serotonin depletion (often nutritional deficiencies) and therefore do not always work in the long term.
In fact some studies have found them only to be equal or even less effective than placebos!
SSRI medications already come with a long list of potential adverse effects, including an initial exacerbation of anxiety, nervousness, difficulty sleeping, nausea, headaches, diarrhoea, dry mouth, increased sweating and sexual dysfunction.
The risk of osteoporosis is not currently listed as an adverse effect of SSRIs, so the general public and even prescribing practitioners may not be aware of this additional downfall of this class of medications.
Hopefully, as the evidence continues to build this will change so that there is a greater public awareness of the risk of osteoporosis when taking SSRI medications and precautionary measures such as bone density screening can be taken.
If you are currently taking an SSRI medication and you are concerned about these side-effects, DO NOT stop taking your medications without consulting your healthcare practitioner first.
Abrupt withdrawal from anti-depressant medications can cause serious side effects and is not advised without medical supervision.
If you are interested in looking into natural mood-supporting alternatives to medications, speak to an Emed Practitioner.
You can also take some simple steps to ensure you are getting enough nutrients in your diet to maintain a healthy bone mineral density AND your mood.
Although we may typically think of our bones as being stagnant and solid, they are actually always in a state of remodeling – breaking down and being rebuilt.
This means that our skeletal system is vulnerable to changes in the environment of the body – for example, an overly acidic system causes calcium to leave the bones and enter the blood stream to act as an acid buffer.
This is why eating an alkaline diet is essential for healthy bones. Read more on simple, nutrient-rich alkalising dietary guidelines here.
Exercise plays an integral role in maintaining musculoskeletal health and is proven to improve mood as well. Aim for 30 minutes a day of weight-bearing exercise such as walking, weight lifting, or climbing stairs.
If you are at higher risk of osteoporosis due to other health conditions such as menopause, malnutrition, hyperthyroidism, glucocorticoid use, etc. smart supplementation may also be of benefit.
- The Connection Between Diet And Mental Health: Part 1 and Part 2
- Understanding Acid/Alkaline and pH Balancing
- Osteoporosis Information Page
Bab, I. et al. 2010, Depression, selective serotonin reuptake inhibitors, and osteoporosis, Current Osteoporosis Reports, Vol. 8(4)
Chen, F. et al. 2012, Do SSRIs play a role in decreasing bone mineral density? Journal of the American Medical Director’s Association, Vol. 13(5)
Haney, E.M. et al. 2010, The Effects of Selective Serotonin Reuptake Inhibitors on Bone Health in Adults: Time for Recommendations about Screening, Prevention and Management? Vol. 46(1)
Harvard Health Publications, 2009, Heavy Heart, Thin Bones?