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Depressed Patients Have More Bone Loss

WebMD Health News

Feb. 29, 2000 (Atlanta) -- A study linking major depression to bone loss offers new clues to why depression increases a person's risk of death.

The study, reported in the January issue of American Journal of Psychiatry, finds greater bone loss in depressed patients --particularly among men -- than in a comparison group. People with depression have high levels of the natural steroid known as cortisol, which has been found to contribute to bone breakdown. Researchers speculate that the findings offer further evidence that high cortisol levels increase the risk of physical illness.

"The whole idea behind this is that patients with untreated major depression die earlier than men and women who are mentally healthy," author Ulrich Schweiger, MD, tells WebMD. "Among patients with depression, only a minority die by suicide, so [there] is a whole spectrum of diseases. The intention is to find out exactly how depression influences general health. One hypothesis is that, in depression, [there are] alterations in body composition ? and that these changes are part of a spectrum of other disorders that lead to increased mortality."

Schweiger, assistant medical director of Lübeck University Psychiatric Hospital in Germany, notes that the study was too small to prove an association between cortisol and disease, and that there was no attempt to study the effects of treatments for depression. But one of the known effects of antidepressant therapy, both with the older tricyclic drugs and with the new serotonin-specific reuptake inhibitors, is that it brings cortisol levels back to normal.

"This might be a way to prevent further bone loss," Schweiger speculates. "The other possibility, but this applies only to women, is that postmenopausal hormone-replacement therapy as already recommended should be more emphasized in patients who are also more depressed. ?If [at some point] the decision is that hormone replacement therapy should be done also for elderly men, then it should be particularly emphasized in men with major depression."

Harold G. Koenig, MD, who reviewed the study for WebMD, says the findings are potentially very significant. "It's not a surprise that bone loss would be linked to depression," he says. "It suggests that the cortisol elevations that are linked to depression can actually cause illness and result in measurable osteoporosis. That?s very important because there has been a question of what are the physical consequences of elevated cortisol in major clinical depression."

Koenig, associate professor of psychiatry and internal medicine at Duke University Medical Center in Durham, North Carolina, suggests that the study findings tie in to the broader area of research into psychological stress, and offer physical evidence that such stress greatly increases illness and death.

"If the effect of depression is great enough to cause osteoporosis, it could also impact immune functioning," Koenig says. "This study suggests that if the [elevations in cortisol] are high enough to cause osteoporosis, this can have clinical consequences -- that's the big thing. If it is that significant, then it could also very well impact immune function and increase the risk of malignancy and malignant spread. For example, if a person had cancer and got depressed, it could facilitate the spread of the disease."

Vital Information:

  • A new study finds greater bone loss in patients with depression, particularly men, compared to a healthy, comparison group.
  • Patients with untreated major depression die earlier than others, which is caused by a variety of diseases and explained only in part by suicide.
  • Researchers speculate that the stress hormone cortisol can cause physical illness.

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