Statement of the problemThe purpose of this study was to determine whether antidepressant medications were associated with a lower dental implant success rate. Materials and methodsA retrospective cohort study was conducted to evaluate dental implants placed in 2015 at the VA North Texas Health Care System. The following inclusion criteria were defined: 1) patients with adequate postoperative follow-up appointments for 5 years; 2) cases with sufficient medical records; 3) patients who had a current diagnosis of depression at the time of implant placement and were taking an antidepressant medication. Patients were excluded as study subjects if: 1) they had inadequate medical records; 2) they were a current tobacco smoker or were undergoing treatment for systemic conditions such as bisphosphonate use, radiation, or chemotherapy. The primary predictor variable was current use of an antidepressant medication. The primary outcome variable was implant success, defined as an implant without pain upon function, no mobility, < 2mm radiographic bone loss from initial surgery, and no history of exudates.1 Secondary predictor variables were age ≥ 65 years and sex, defined as male or female. Descriptive, bivariate, and multiple logistic regression analyses were performed with P < .05 used to determine statistical significance. Results and outcomesThirty-one patients and 67 implants met the defined inclusion and exclusion criteria. The average age was 65 years. Fifty-two implants were placed in patients 65 years and older. Sixty implants were placed in males, and 7 were placed in females. Sixty-one implants met the defined success criteria (91%), with 7 implant failures (7%). Forty-six implants were placed in patients on antidepressant medication. The antidepressant treatment group had 41 implants that met success criteria (89%) and 5 implant failures (11%). Analysis of the predictor variable and primary outcome variable revealed that antidepressant therapy was associated with a nearly 60% decrease in success (OR 0.41; 95% CL 0.04-3.75), but was not statistically significant (P = .6542). Analysis of the secondary variables reveled that age ≥ 65 and female sex were not associated with statistically significant differences in dental implant success (P = 1 and P = .4927, respectively). Discussion and conclusionThe results of this retrospective analysis suggest that antidepressant use does not affect the success rate of dental implants. A systemic review by Silva et al found an increased risk for implant failure in antidepressant users compared to non-users, but cautioned their conclusions due to a lack of methodological rigor and standardization.2 They found an increased rate of dental implant failures in tobacco smokers who also took antidepressants. They hypothesized that tobacco smoke can be a surrogate for dental implant failure in patients taking antidepressants as nicotine can impair new bone formation and impair osseointegration, artificially inflating the rate of implant failure in this cohort. One of the strengths of the current study is strict rule-out criteria for current tobacco smokers, as patients who receive implants at this center have point-of-care nicotine testing prior to implant placement. The results of this present study suggest that antidepressant use does not decrease implant success rates over a 5-year period. Future prospective studies, with larger cohorts, will be performed to further elucidate the association between antidepressant use and dental implant success.