Abstract
The association between selective serotonin reuptake inhibitor (SSRI) treatment and lower bone mineral density (BMD) remains controversial, and further research is required. This study aimed to compare the BMD, levels of bone formation and bone metabolism markers in medicated premenopausal Singaporean women with major depressive disorder (MDD) and matched healthy controls. We examined 45 women with MDD who received SSRI treatment (mean age: 37.64 ± 7) and 45 healthy controls (mean age: 38.1 ± 9.2). BMD at the lumbar spine, total hip and femoral neck were measured using dual-energy X-ray absorptiometry. We also measured bone formation markers, procollagen type 1 N-terminal propeptide (P1NP) and bone metabolism markers, osteoprotegerin (OPG) and receptor activator of nuclear factor-kappa-Β ligand (RANKL). There were no significant differences in the mean BMD in the lumbar spine (healthy controls: 1.04 ± 0.173 vs. MDD patients: 1.024 ± 0.145, p = 0.617, left hip (healthy controls: 0.823 ± 0.117 vs. MDD patients: 0.861 ± 0.146, p = 0.181) and right hip (healthy controls: 0.843 ± 0.117 vs. MDD patients: 0.85 ± 0.135, p = 0.784) between healthy controls and medicated patients with MDD. There were no significant differences in median P1NP (healthy controls: 35.9 vs. MDD patients: 37.3, p = 0.635), OPG (healthy controls: 2.6 vs. MDD patients: 2.7, p = 0.545), RANKL (healthy controls: 23.4 vs. MDD patients: 2178.93, p = 0.279) and RANKL/OPG ratio (healthy controls: 4.1 vs. MDD patients: 741.4, p = 0.279) between healthy controls and medicated patients with MDD. Chronic SSRI treatment might not be associated with low BMD in premenopausal Singaporean women who suffered from MDD. This finding may help female patients with MDD make an informed decision when considering the risks and benefits of SSRI treatment.
Highlights
Major depressive disorder (MDD) is a common psychiatric disorder with a lifetime prevalence of 10.8% [1]
There were no significant differences in age (p = 0.757), ethnicity (p = 0.1494), smoking status (p = 0.17), body mass index (BMI) (p = 0.362), cholesterol (p = 0.85), triglycerides (p = 0.852), HDL-c (p =0.472), LDL-c (p =0.995), exercise duration (p = 0.975), menarche age (p = 0.876) and duration of menstruation (p = 0.376)
Our study found that premenopausal Singaporean women treated with Selective serotonin reuptake inhibitors (SSRI) showed similar bone mineral density (BMD) at three skeletal sites, levels of bone formation (i.e., procollagen type 1 N-terminal propeptide (P1NP)) and bone metabolism (i.e., OPG, receptor activator of nuclearfactor-kappa-B ligand (RANKL), RANKL/OPG ratio) markers when compared to healthy controls
Summary
Major depressive disorder (MDD) is a common psychiatric disorder with a lifetime prevalence of 10.8% [1]. Antidepressant medication represents a treatment option in people suffering from MDD. Selective serotonin reuptake inhibitors (SSRI), including fluoxetine, paroxetine and sertraline, have the highest popularity index among all biological treatments for MDD [2]. A previous study found that premenopausal women suffering from MDD had low bone mineral density (BMD) and high bone metabolism turnover [3]. Another study reported that patients treated with antidepressants might have decreased BMD, putting the patients at an increased risk of fractures [4]. It has been reported that patients receiving antidepressant treatment may be at increased risk for osteoporosis or osteoporotic fractures [5]
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