Depression, antidepressants, and bone health in older adults: a systematic review.

Abstract

To the Editor: We concur with Gebara et al.’s1 conclusion that there is compelling evidence of an association between depressive illness, antidepressant use, and bone health in older adults. What was not specifically addressed was the question of continued antidepressant use past therapeutic indication and the implications for bone health sequelae in older adults. Major depressive disorder is a common and serious illness. Effective treatment includes antidepressants, which should be continued for at least 6 months after remission of a major depressive episode to reduce the risk of relapse.2, 3 Further evidence has accumulated supporting continued antidepressant treatment for 9–12 months after remission and indeterminate maintenance treatment for recurrent depression to minimize the risk of further episodes,4, 5 but many older adults are inadvertently kept on antidepressants for long-term treatment without proper indication. This may happen because of inadequate monitoring or unfounded concerns regarding recrudescence of depression with treatment removal. This use may be associated with significant bone health sequelae, and must be considered in concurrence with osteopenia, osteoporosis, and risk of falls and fractures. Careful monitoring and reassessment are needed, and future research is warranted in this area. Such research should determine the cost:benefit ratio of long-term antidepressant use and bone health in older adults. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: All authors were responsible in the preparation of this letter. Sponsor's Role: N/A.