The People's Perspective on Medicine

Will Antidepressant Medications Increase Your Risk for a Broken Hip?

Antidepressants are thought to be highly effective and quite safe. Millions take such drugs. An unexpected complication of antidepressants is worrisome.

Antidepressants are among the most popular pills in the drugstore. A research letter in JAMA Internal Medicine (Dec. 12, 2016) noted that one in six adults take psychiatric drugs. Antidepressant medications make up the largest number of those pills (12 percent). The authors point out that “Among adults reporting taking psychiatric drugs, more than 8 of 10 reported long-term use.” Older people and women are the most likely to be taking such medications. In a moment you will discover why that is a potential problem

When fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft) were first introduced, most people believed there were few side effects. No one ever imagined something as serious as hip fractures. It wasn’t even on the radar screen. But in recent years there have been some disturbing reports that antidepressants can increase the risk of fractures in general and broken hips in particular.

The Latest Research on Antidepressant Medications:

A Finnish study of more than 50,000 people with Alzheimer’s disease and 100,000 without dementia found a two to three fold higher risk for hip fracture during antidepressant use compared to nonuse (International Journal of Geriatric Psychiatry, Jan. 5, 2017). The authors note that:

“Antidepressants are widely used among older persons and especially among persons with Alzheimer’s disease (AD)…

“use of antidepressants is associated with adverse drug events among older persons. Most severe events are gastrointestinal bleedings, stroke and hyponatremia [very low sodium levels]. Antidepressant use has also been associated with an increased risk of injurious falls, leading to fractures…

“We found two-three times higher risk for hip fracture during antidepressant use compared with non-use among older persons. Our findings are consistent with previous studies on the association between antidepressant use and an increased risk of hip fracture conducted in general aged population, pointing out two times higher risk for hip fracture associated with antidepressant use compared with nonuse.”

The authors warn that if older people must take antidepressant medications, they should be carefully monitored to prevent falls

Prior Research Linking Antidepressant Medications to Fractures:

This is not the first time antidepressants have been associated with a greater chance of falls and fractures. Some critics might suggest that people who are depressed are vulnerable to falls whether they are taking antidepressants or not. A study published in the journal Injury Prevention (online, June 2015) suggests otherwise. This study involved 137,000 women who were not depressed. It demonstrated a link between drugs like citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac) and sertraline (Zoloft) and fractures. The women were taking these medications for hot flashes, not depression.

How Do Antidepressant Medications Cause Fractures?

Most health professionals would probably assume that antidepressant medications cause sedation, dizziness, irregular heart rhythms, low sodium levels or confusion. Such side effects are recognized as adverse drug reactions induced by this class of medications. When someone is dizzy, unsteady on her feet or confused, falls and fractures are a distinct risk. But there is another possibility. Most of these antidepressants are known as SSRIs (selective serotonin reuptake inhibitors). That means they affect the brain chemical called serotonin.

What many people may not realize is that serotonin is found throughout the body. There are serotonin receptors on specialized bone cells called osteoblasts and osteocytes. In other words, serotonin plays a critical role in bone health. What researchers do not yet know, however, is whether SSRI-type antidepressants adversely affect bone structure and increase the risk of osteoporosis (Current Osteoporosis Reports, Oct., 2016). This just demonstrates that it can take decades before adverse drug effects are discovered and the mechanism worked out.

NEVER Stop Antidepressant Medications Suddenly!

When people stop drugs such as citalopram, duloxetine or sertraline suddenly they can experience horrible withdrawal symptoms.

Here is one story from Karlyn in Florida:

“I was put on Celexa after treatment for breast cancer for hot flashes. I was eventually placed on Zoloft because it was said to be easier to stop taking. However, it has been 14 years, and I have been unable to withdraw from the medication. I tried for 10 months (after coming off the drug gradually and receiving acupuncture) and was sick every day, all day for those 10 months. I finally started taking the drug again with complete relief. Now, I am stuck taking Zoloft. I have never been depressed except during that 10 months almost five years ago. I am an SSRI drug ‘addict’ and CANNOT do without it. All for hot flashes which I no longer suffer from at all.”

Any older woman who has been taking an antidepressant medication should ask her physician whether it would be appropriate to be checked for osteoporosis. In addition, steps should be taken to make the house or apartment less dangerous. Anything that represents a trip hazard should be immediately fixed. Hand holds and other safety devices should be installed. A hip fracture can be devastating and we want to make sure that People’s Pharmacy visitors are protected now that we know this class of medication represents a substantial risk, especially for older people.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I have taken Paxil for 20 years for anxiety and panic attacks. This is the first I’ve heard about falls and fractures! Is there anything else for panic attacks and anxiety that isn’t harmful?

My doctor put me on statins. When I became lethargic, confused and sad she recommended anti-depressants and sent me to see a psychiatrist. Having been depressed in the past, I knew the difference, and refused to take them. Fortunately I read here about the side affects of statins, and I read the small print for my medication. I saw all my symptoms, and self-diagnosed my problem. The doctor consistently tries to persuade me to go back on the statins as I have a 24 percent chance of having a heart attack in the next 10 years … I looked at her and said, “Let me get this straight: You think it is best for me to be lethargic, confused and miserable for 10 years because I have a 76 percent chance of nothing happening to me?”. We continue the “dripping water” torture of advice, I think losing some more weight might be a better cure.

I took sertraline and venlafaxine for many years before finding out that you should never take both at the same time. Due to a mistake by the pharmacy, I ran out of sertraline and did without for long enough to realize I did not need it.

I felt better, and now I like myself much better. I no longer avoid people, I take part in conversations I formerly avoided. I no longer hide my thoughts or opinions. Like I said, due to a pharmacy mistake, I stopped cold turkey and learned I was given these meds unnecessarily.

Oh, swell! Another risk from a medication that is helping me with a different health issue. I already have osteopenia, and I’m due for a bone density scan this year. I’ll be bringing this article along to my visit. I do weight-bearing exercise, try to get as much calcium as possible from my diet since my Internist doesn’t want me taking calcium supplements due to the possibility of calcium deposits showing up in blood vessels.

I’m not going to stop taking my SSRI antidepressant medication unless my prescribing physician has something better to offer me. Before I started it, I could barely manage a smile. My SSRI isn’t making me sleepy or dizzy; I feel like a normal person, so I guess it’s the serotonin factor.

Thanks for the info. It’s better to be informed than ignorant; denial isn’t an option either.

For many like you Susan an SSRI makes a huge difference. In your case the benefit of the medication may far outweigh any risk of a fracture. Just be extra cautious about trip hazards.

Your title says “antidepressants”, but the studies quoted are about SSRI’s. They are only one of several types of antidepressants. Your text continues to alarm about “antidepressants”. I am taking Wellbutrin, an antidepressant that is NOT an SSRI. Please be more accurate. You are misleading us.

Sorry, but 1 in 6 taking an antidepressant! That’s depressing in itself. How does this happen? Do this many people actually feel they are depressed? And do they honestly believe a pill will help?

It’s just mass marketing and mass prescribing as far as I’m concerned. Oh yeah, antidepressants are linked to suicide also. A bit worse than being depressed, if they were in the first place.

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