Depressed Patients Have More Bone Loss
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."