Major depressive disorder (MDD), one of the most common mental illnesses affecting people from all over the world, leads to the development of major disabilities. Past research shows that MDD induces bone loss and increases the risk of osteoporotic fractures in adults and elderly people across ethnicities. Selective serotonin reuptake inhibitors (SSRIs) and other medication used for treating MDD have also been linked to bone loss and an increased risk of fractures in adults.
Although studies have investigated the correlation between MDD and low bone mineral density (BMD) in adolescents, overall research is limited. A new study published in the Journal of Bone and Mineral Research (JBMR) on Aug. 16, 2017, has established a link between MDD, generalized anxiety disorder (GAD), use of SSRIs and changes in bone metabolism among older adolescents and young adults. A team of researchers led by Chadi A. Calarge, associate professor in the department of psychiatry and behavioral sciences at the Baylor College of Medicine, Texas, evaluated 264 clinically fit 15- to 20-year-olds who were neither on medication nor had started using SSRIs up to a month before the study.
Results of the study show that MDD severity was associated with increasing BMD in this age group, especially higher lumbar spine areal BMD (LS aBMD). The use of SSRIs led to an increase in LS aBMD in females but caused a decline in males. An independent but weak correlation was found between GAD and increased bone mineralization.
Link between psychiatric disorders and teen bone density
Results of another study which appeared in JAMA Pediatrics in December 2016 showed that bone mineral content (BMC) and BMD were significantly lower in children and adolescents taking stimulant medication for attention-deficit/hyperactivity disorder (ADHD) compared to those who were not. Study participants were aged between 8 and 20 years. For those above 16 years, data on medication use was collected by means of self-reporting whereas for younger participants it was collected via proxies. Compared with nonusers, children and adolescents using stimulants had a significantly lower bone mass of the lumbar spine and femoral neck.
The impact of depression and antidepressants on bone metabolism has still not been fully understood. Depression is known to activate the hypothalamic-pituitary-adrenal (HPA) axis which causes adverse biological impacts due to high levels of the stress hormone cortisol and corticotropin-releasing hormone (CRH). It also results in high levels of immune cells which cause inflammation. The impact of these chemical changes may be harmful to bones. Studies investigating neurotransmitter regulation and bone metabolism suggest that the nervous system may influence bone metabolism. Research has also attempted to show the detrimental impact of SSRIs on bone mineral accrual, although results are mixed.
Calarge and his colleagues acknowledge that in trying to establish a specific link between depression, use of SSRIs and bone mass in adolescents and older adults, a “complex picture” has emerged. This is due to the findings that depression results in low bone mass and over time leads to greater, site-specific increase.
Discussing bone health along with mental health
The researchers write that since SSRI use was independently associated with a site-specific reduction in bone density among males, future research should explore approaches and interventions “to attenuate these treatment effects in males.” Since research is increasingly pointing to evidence of a correlation between SSRIs and bone loss, it may be beneficial for doctors and patients to discuss bone health simultaneously with mental health.
If you know an adolescent who is exhibiting signs of teen depression or teenage anxiety, White River Academy can help. Located in Utah, it is one of the leading therapeutic boarding schools that can help in diagnosing and treating teenage depression and other mental health problems. Call our 24/7 helpline or chat online with one of our representatives to know more about teenage depression treatment.