Depression and Bipolar info explaining the latest research in everyday English


Do SSRIs erode your bones?

There's a growing body of evidence that SSRIs are eroding bones, resulting in increased risks of osteoporosis and fractures.

The Harvard Mental Health Letter for August 2009 reports on a ten-year history of research that noticed a disturbing correlation (a seeming relationship between two sets of data): depressed patients had lower bone strength and a greater risk of fractures.

Although the earlier studies left the door open to a pharmaceutical reason for increased risk of fracture (as in, the medications used may have caused dizziness, resulting in falls and fractured bones), later studies have been better-designed and seem to implicate SSRIs are causing bone erosion.

Two recent significant studies appear to conflict. One finds that inhibiting 5-HTT, which SSRIs do better than any other antidepressants, slows bone formation and accelerates bone resorption (which is when calcium and other minerals are released into the bloodstream, leaving trenches behind in the bones); the other finds that inhibiting 5-HTT actually increases bone mass.

5-HTT is the transporter mechanism for 5-HT, which you might know as serotonin; SSRIs enhance serotonin activity.

Despite the conflict between the two aforementioned studies, the Canadian Multicentre Osteoporosis Study Research Group followed 5,008 men and women who were aged 50 and over for five years, finding that the patients who were taking SSRIs everyday had lowered bone mineral density measurements, particularly in the hip. They were also twice as likely as non-SSRI-taking patients to suffer a bone fracture.

Ways to overcome any risk of bone erosion include increasing the intake of calcium, increasing the intake of vitamin D, reducing the amount of caffeine and alcohol taken, and exercising in a way that bears weight on bones (such as walking, weight lifting, stair climbing). It also seems that some medications help slow bone resorption: alendronate (Fosamax), risedronate (Actonel) and ibandronate (Boniva) are mentioned positively.

Of equal significance is that no one has yet taken a look at how SSRIs might affect the bones of children or teenagers.

Source: Harvard Mental Health Letter, August 2009 -

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Sunshine on my shoulder makes me happy: the benefits of vitamin D supplementation

Recent clinical trials of vitamin D supplementation have shown that doses far above the 'recommended dose' are producing great results.

For example, sufferers of cardiovascular disease, falls and fractures, multiple sclerosis, Crohn disease, pain, autism (possibly), and diabetes mellitus have been shown to have benefitted from higher than recommended doses of vitamin D supplementation.

Of interest to me is the finding that above-recommendation dosage of vitamin D can also assist in the treatment and management of depression and Seasonal Affective Disorder (SAD).

A study in Australia apparently found that 4,000 IU per day for 2 months of vitamin D3 improved mood significantly more than 600IU per day, with no ill effects.

Even though sunlight is the most natural way to top up one's vitamin D levels, the risk of skin cancer (particularly in Australia) counters the idea of spending hours in the sun. The ingrained Aussie habit of slipping on a shirt, slapping a hat and slopping on sunscreen means that exposure to vitamin D is reduced.

Vitamin D levels can also be depleted by drugs, including barbiturates, carbamazepine, cholestyramine, cimetidine, colestipol, corticosteroids, famotidine, fosphenytoin, isoniazid, mineral oil, nizatidine, phenobarbital, phenytoin, ranitidine, and rifampin. Kauffman additionally notes that cholestyramine and colestipol also deplete cholesterol.

"Sodium valproate is one of the few [ ] drugs that lower vitamin D levels and one of the few gestational drugs that lead to autism," states Cannell [Cannell JJ, Autism and vitaminD. MedHypotheses 2008;70:750-759.]

Kaffman also suggests that there is a potential cancer link between vitamin D depletion and the use of prevastatin [Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002;360:1623-1630.]

Good sources of vitamin D (apart from the sun) include fish, cod liver oil, and shiitake mushrooms. A more complete list is available from Holick, MF. Vitamin D deficiency. NEngl JMed 2007;357:266-281.

But if you ARE going to bask under the sun's golden rays, apparently a mere 15 minutes of summer noonday sun on both sides of the body will generate the equivalent of 10,000 IU of D3 in most light-skinned adults. Apparently a repeat top-up once or twice a week is all that's needed to keep one's levels up. Glass, plastic and clothing will seemingly absorb nearly all UV-B from sunlight.

Even safer (for us Australians, anyway) is grabbing just 5-10 minutes of direct sun on the arms and legs; it generates around 3,000 IU. That's easy to accomplish by the simple act of driving to pick up the kids from school, walking to the shops, walking around the park for exercise, and so on.

We know that exercise is beneficial in the treatment and management of depression; it looks like getting some sunshine is an additional help.



Source: Kauffman, Joel M.(2009) Benefits of Vitamin D Supplementation, Journal of American Physicians & Surgeons; Summer2009, Vol. 14 Issue 2, p38-45

Joel Kauffman, PhD., is professor of chemistry emeritus at University of the Sciences in Philadelphia and a freelance writer on medical topics.

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