title: The adverse skeletal effects of selective serotonin reuptake inhibitors.
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.
authors.affiliation: Maudsley Hospital & Institute of Psychiatry, King's College London, London, UK.
authors.forename: E M
authors.initials: EM
authors.lastname: Tsapakis
authors.forename: Z
authors.initials: Z
authors.lastname: Gamie
authors.forename: G T
authors.initials: GT
authors.lastname: Tran
authors.forename: S
authors.initials: S
authors.lastname: Adshead
authors.forename: A
authors.initials: A
authors.lastname: Lampard
authors.forename: A
authors.initials: A
authors.lastname: Mantalaris
authors.forename: E
authors.initials: E
authors.lastname: Tsiridis
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects*; D001842:Bone and Bones / Q000187:drug effects*; D003866:Depressive Disorder / Q000188:drug therapy; D006801:Humans; D010024:Osteoporosis / Q000139:chemically induced*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors