Bone Loss and Antidepressants. Is There a Connection?

More than 1 in 8 adults in the U.S. take antidepressants, and these common medications could be connected to bone health, especially in women. Antidepressants fall under the class of drug known as selective serotonin reuptake inhibitors (SSRIs), a popular treatment option for mental health disorders. SSRIs are also frequently prescribed to help treat menopausal symptoms including hot flashes and night sweats, and can be used to treat sleep and pain disorders.

Recent studies have found a link between the treatment for depression and bone health, suggesting that prolonged use of SSRIs weakens the bones and increases the risk of bone fractures. One study found that women who take antidepressants like Prozac, Paxil, Celexa and Zoloft have been linked to a 76% increased risk of bone fractures. SSRIs treat depression by increasing the level of serotonin in the brain, while at the same time increasing cortisol (the body’s stress hormone), which can inhibit bone formation.

Other researchers have found a link between depression itself and bone health, including reduced bone density, accelerated bone loss or an increased risk of fractures. The direct connection is still not known, but it’s thought depression can disrupt the levels of serotonin, which is considered a neurotransmitter that helps regulate bone mass. In addition, depression itself may cause weight loss, less physical activity, or other behaviors that could be detrimental to bone health.

Women are nearly twice as likely as men to be diagnosed with depression. And though depression can occur at any age, the risk of depression can increase during perimenopause, when hormone levels fluctuate drastically, or during early menopause or post-menopause, when estrogen levels are significantly reduced. The drop in estrogen speeds up bone loss, which is one of the reasons women are twice as likely to have osteoporosis, a disease that causes bones to become thin and weak and increase the risk of breakage while doing basic, daily activities.

It’s estimated that 10 million people over the age of 50 have osteoporosis. Common risk factors include family history, low body mass or being underweight, physical inactivity or prolonged bedrest, hysterectomy prior to menopause, smoking and heavy alcohol use and medical conditions like rheumatoid arthritis and chronic kidney disease. You can have low bone density (known as osteopenia) at any age without having osteoporosis, but it does increase your risk of developing osteoporosis.

While the relationship between depression, treatment and bone loss is complex and understudied, it’s important to be aware of their connection. Talk to your doctor if you have concerns about your bone health and if you are over the age of 50, ask your provider about bone density testing, medications and lifestyle changes that can help slow bone loss.