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The adverse skeletal effects of selective serotonin reuptake inhibitors

Published online by Cambridge University Press:  15 April 2020

E.M. Tsapakis ,
Z. Gamie ,
G.T. Tran ,
S. Adshead ,
A. Lampard ,
A. Mantalaris  and
E. Tsiridis
E.M. Tsapakis
Affiliation:
Maudsley Hospital & Institute of Psychiatry, King's College London, London, UK, SE5 8AF
Z. Gamie
Affiliation:
Maudsley Hospital & Institute of Psychiatry, King's College London, London, UK, SE5 8AF
G.T. Tran
Affiliation:
Maudsley Hospital & Institute of Psychiatry, King's College London, London, UK, SE5 8AF
S. Adshead
Affiliation:
Maudsley Hospital & Institute of Psychiatry, King's College London, London, UK, SE5 8AF
A. Lampard
Affiliation:
Maudsley Hospital & Institute of Psychiatry, King's College London, London, UK, SE5 8AF
A. Mantalaris
Affiliation:
Maudsley Hospital & Institute of Psychiatry, King's College London, London, UK, SE5 8AF
E. Tsiridis*
Affiliation:
Maudsley Hospital & Institute of Psychiatry, King's College London, London, UK, SE5 8AF
*
*Corresponding author. Direct line: +113 3922621; mob: +77 8685 8586; Secretary: Tel.: +113 3929901; fax: +113 3923290. E-mail address: etsiridis@doctors.org.uk (E. Tsiridis).
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Abstract

Selective serotonin reuptake inhibitors (SSRIs) are a widely used group of antidepressants (ADs) with reported potential detrimental effects on bone mineral density (BMD) and increased fracture risk. Here, a comprehensive review of the in vitro, in vivo and clinical studies to date was carried out using the medical search engines MEDLINE (1950 to September 2010) and EMBASE (1980 to September 2010). Serotonin (5-HT) receptors have been identified on osteoclast, osteoblast and osteocyte cell lines. The effect of SSRIs on bone formation and resorption appears to be governed by the activation of a number of 5-HT receptors on osteoblasts and osteoclasts via endocrine, autocrine/paracrine and neuronal pathways. In vitro, in vivo and clinical collective data appears to indicate that SSRIs have a negative effect on bone at the therapeutic dose levels widely used for the treatment of depression in current clinical practice. Caution may therefore have to be employed with the use of SSRIs in patients at an increased risk of falls and osteoporosis. Further studies are needed in order to fully elicit the role of SSRIs in bone formation and their effects in the low oestrogen state.

Keywords

SerotoninReuptakeInhibitorBoneResorptionFormation
Type
Review
Information
European Psychiatry , Volume 27 , Issue 3 , April 2012 , pp. 156 - 169
Copyright
Copyright © Elsevier Masson SAS 2012

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