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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Karen's World on September 13, 2008, at 18:15:07
Yikes! I just found out that I have osteoporosis in my spine and am only 49 years old. According to my doctor, one of the risk factors is taking SSRI's, which I have done for the past 7 years (Celexa). Has anyone else had a similar experience with SSRI's? This is really disheartening since I have been happy with Celexa in every other way and don't know what else to go on - a tricyclic antidepressant? Please share experience or advice.
Posted by desolationrower on September 13, 2008, at 18:54:58
In reply to SSRI's and Osteoporosis, posted by Karen's World on September 13, 2008, at 18:15:07
WEll before you give up a med that is working for you, can you change any of the other risk factors? I am not really in a group at risk for this so theres probably lots more you can do but weight lifting, calcium & magnesium, vitamin D (d3) & K (k2), not smoking, and some medications all can help. I believe depression also is associated with oesteoporosis so so your citalopram may not be that much of a bad guy here.
-D/R
Posted by Karen's World on September 13, 2008, at 19:17:55
In reply to Re: SSRI's and Osteoporosis, posted by desolationrower on September 13, 2008, at 18:54:58
D/R: You've made a very good point. I know many of the other risk factors and yes, I have a few...in my case it is not genetic, however; I don't smoke; I take calcium, magnesium and D3 as well as fish oil. My job is very sedantary, which I know doesn't help, but I try to walk/or swim a few times a week. I have a medium build and am caucasian. Celexa is the only med that I'm on or ever have been on for any extended period of time. What is K, by the way?
I tried Actonel and had a very bad reaction, so biphosphanates(sp?)are out - my doctor wants me to try calcitonin injections now. I'm going to try weight bearing exercises...Anyway, the whole thing is very scary to me.
Thanks for your post.
Posted by Phillipa on September 13, 2008, at 21:40:48
In reply to Re: SSRI's and Osteoporosis, posted by Karen's World on September 13, 2008, at 19:17:55
I also have it and take ca mg and won't take the fosamax or boniva. I have thyroid hasimotos and that is a risk factor my endo tested D and has me on l000 a day and it was 40 which was good. And ad's don't work for me so if it works stay on it. Love Phillipa ps never heard SSRI's were a risk factor any links?
Posted by desolationrower on September 13, 2008, at 23:06:43
In reply to Re: SSRI's and Osteoporosis, posted by Karen's World on September 13, 2008, at 19:17:55
Vitamin K. Most known for being important to blood clotting. IT has been shown to help with osteoporosis. K2 (menaquinone) is the best form.
-D/R
Posted by Karen's World on September 13, 2008, at 23:25:15
In reply to Re: SSRI's and Osteoporosis » Karen's World, posted by Phillipa on September 13, 2008, at 21:40:48
Phillipa:
My gynecologist was the one who told me about it and made me have a bone scan. I found the following articles on the internet regarding the link between ssri's and bone loss. Here they are:
http://firstwatch.jwatch.org/cgi/content/full/2007/626/3
http://findarticles.com/p/articles/mi_m0CYD/is_23_39/ai_n8581182
http://www.webmd.com/depression/news/20070625/antidepressants-may-speed-bone-loss
http://www.sciencedaily.com/releases/2007/06/070626115436.htm
There are actually more articles than the above, but they all say about the same thing. Pretty compelling stuff - so I can either be a happy hunchback with brittle bones or depressed and anxiety-ridden with a strong, straight spine - not much of a choice. Maybe TCA's?
Posted by Racer on September 14, 2008, at 2:32:33
In reply to Re: SSRI's and Osteoporosis, posted by Karen's World on September 13, 2008, at 23:25:15
Honestly, if it's working for you, I'd look at ways to mitigate the bone loss before considering a switch.
TCAs come with far more adverse effects than SSRIs, some of which are more severe than those associated with SSRIs. That's certainly something to weigh in making your decision on this. You didn't mention what your reaction to the bisphosphonate was, but I'm wonder if it was a tolerability question, or something more serious? If it's a question of tolerating it, maybe it's worth thinking about whether you can find a way to mitigate the effects?
I had my first bone scan at 39, and came up with scary numbers. I think it was -1.6 and -2.1, hip/spine. Maybe it was 1.6 and 1.9, it's been a while. At the time, I was undergoing fertility treatment -- ultimately unsuccessful -- so I couldn't start bisphosphonates. Instead, my doctor directed me to take 1500mg of calcium per day, along with 750 magnesium, and to gain some weight. I had a follow up scan done when we gave up on fertility, and my bone density had improved a good deal -- I was still mildly osteopenic, but not to the extent that my doctor recommended starting the bone pills yet. It could be that weight bearing exercise and higher doses of calcium will be helpful for you, too.
Best luck, and I hope you'll stick around and let us know how it goes.
Posted by seldomseen on September 14, 2008, at 9:57:57
In reply to Re: SSRI's and Osteoporosis, posted by Karen's World on September 13, 2008, at 23:25:15
I wouldn't be too quick to jump off the SSRI bandwagon, especially if they are working for you. Each of the studies you quoted (especially in the one in archives of internal medicine) has significant flaws.
Press releases regarding the studies tend to overgeneralize results.
There is something called *confounding by indication* which complicates each of the studies. In its simplest form, this confounder makes it impossible to determine whether the underlying illness or the drug taken for it causes the condition.
In my opinion, ideally, the studies would form a cohort of depressed people who aren't being treated and those depressed subjects that are and look at the outcome of osteoporosis.
This study design has some significant ethical problems as you may imagine.
Posted by Karen's World on September 14, 2008, at 12:52:12
In reply to Re: SSRI's and Osteoporosis » Karen's World, posted by seldomseen on September 14, 2008, at 9:57:57
I understand that it hasn't been "scientifically" proven yet. But, would it even be possible to have a control group of depressed people who didn't taken any meds and track them for a long period of time? Some of them probably wouldn't even be alive after awhile!
Since my bones are a stake here, I tend to take these findings pretty seriously. Also, my gynecologist was the one who warned me about this. I didn't just run across these articles on the internet first.
Anyway, I appreciate your input and perspective on this. I may just reduce my dose of Celexa (I'm taking 60Mg per day) and try to augment with something else - maybe more fish oil.
Posted by Nadezda on September 14, 2008, at 13:06:49
In reply to SSRI's and Osteoporosis, posted by Karen's World on September 13, 2008, at 18:15:07
Another thing I've heard that affects osteoporosis is drinking coke. I don't know why-- but apparently this doesn't pertain to other soft drinks-- possibly something about coke having a lot of potassium.
Don't know if you drink it, but if you do, it would be worth cutting it out.
I'm really sorry to hear that you have osteoporosis, though -- and also that you can't take any of the most common meds. How well do the calcitonin injections help?
Nadezda
Posted by Karen's World on September 14, 2008, at 13:16:27
In reply to Re: SSRI's and Osteoporosis, posted by Racer on September 14, 2008, at 2:32:33
My reaction to the bisphosphonate was severe neck and shoulder pain first, then it seemed to spread downward through my body each day and affected all my muscles and joints with severe pain and stiffness. My fingers got swollen and the joints got little knots on them. I was also feverish, weak and tired. These symptoms lasted a little over a week. Sorry, but I cannot go through that again and I don't think my body would appreciate it either. However, I was disappointed.
I am now in menopause (it's been 11 mos since my last period), so I know that that can contribute to bone loss too. I just want the bone loss to stop - my t score in the spine went from -2.2 to -2.7 in one year. My doctor is putting me on calcitonin injections. I hope I can tolerate that. Thanks for your encouragement to stay on the SSRI's as they have changed my life.
I'll keep you up to date on my progress.
Posted by Karen's World on September 14, 2008, at 13:21:13
In reply to Re: SSRI's and Osteoporosis, posted by Nadezda on September 14, 2008, at 13:06:49
I don't drink Coke, but was quite a Pepsi fan for most of my life, until recently. I read about soda affecting the bones and have cut it out altogether. So, yes, that may have contributed to my bone loss. I'm drinking tea now. I'm not totally sure that that's ok. My doctor says it is, but I have read that caffeine is not good for the bones either.
I haven't started the calcitonin injections yet. Will write a post once I do.
Posted by Racer on September 14, 2008, at 14:08:43
In reply to Re: SSRI's and Osteoporosis, posted by Karen's World on September 14, 2008, at 12:52:12
> I understand that it hasn't been "scientifically" proven yet. But, would it even be possible to have a control group of depressed people who didn't taken any meds and track them for a long period of time? Some of them probably wouldn't even be alive after awhile!
I'm a little dismayed to see you using quotation marks around the word scientifically. "Scientifically" means using the scientific method, and the scientific method is one of the most powerful intellectual tools we have. "Scientifically proven" means that something can be tested, can be reproduced, it's not just a coincidence! If Celexa has "changed your life," do you want to risk losing that because of something which might have been a very simple coincidence, rather than an effect of the drug?
Also, yes -- studies could have been designed to avoid some of the biases SeldomSeen is referring to. She's smart, and she's a professional, so I usually defer to her knowledge on these matters. If she's pointing out a problem, she knows whereof she speaks. And did I mention she's very smart?
>
> Since my bones are a stake here, I tend to take these findings pretty seriously. Also, my gynecologist was the one who warned me about this. I didn't just run across these articles on the internet first.I've heard some very misleading or factually incorrect information from medical professionals. They have their own biases, just as we do. I've had doctors tell me that the antidepressants are just a crutch, and I'm not really doing anything in therapy if I'm taking them! Doctors are human, after all, and the human condition includes personal biases.
What's more, some doctors are not terribly critical about certain sorts of information. Sometimes even very, very good doctors will accept studies outside their own specialty quite uncritically, especially if they include conclusions which fit their expectations or biases.
Again -- if the medication is working for you, it's worth looking at options for mitigating the bone loss, rather than dropping an effective treatment for a serious condition.
Lowering your dose might be helpful -- but only if the effects of SSRIs on bone density loss are dose related. They may not be. And, of course, the bone loss shown in those studies may be confounded by other factors.
Peace.
Posted by Karen's World on September 14, 2008, at 16:51:35
In reply to Re: SSRI's and Osteoporosis » Karen's World, posted by Racer on September 14, 2008, at 14:08:43
Sorry, I did not mean to insult anyone's intelligence here (or put my own up for scrutiny). When a drug company lists the possible side effects of a drug, those side effects have not always been proven by the scientific method. They are usually listed as a result of a study where certain variables are controlled, but not all. Its just not always feasible to do that.
Also, I certainly don't take everything at face value that my doctor says. That's the very reason that I read and post on this message board!
In fact, I had been suspicious of his motives all along...first prescribing birth control pills to control my depression (Boy, was that a flop. Even though I stayed on Celexa, they still made me depressed, so quit them pronto). Then, he prescribed the Nuva Ring (birth control) when my bone scan showed osteopenia last year - another flop. He also tried to push Fosamax on me at that time, but I didn't take it. So, yes, it appears that the birth control drug companies and
the bone drug companies might possibly have him in their hip pocket. I don't know for sure, but did switch doctors. The new one had not heard about the ssri/osteoporosis link. However, its still in the back of my mind and I did find articles about it on the internet.I'm not going to immediately dump my Celexa, that's for sure. I just wanted some feedback from others to see if anyone else had experienced this or had any thoughts about it. I was also curious about the TCA's. I appreciate your post.
Posted by Racer on September 14, 2008, at 17:28:04
In reply to Re: SSRI's and Osteoporosis, posted by Karen's World on September 14, 2008, at 16:51:35
I had to kinda laugh when I read your doctor's history of 'treating' your depression -- I'm thinkin' maybe he might have, like, some kinda, I dunno, bias against antidepressants? My goodness -- and pushing birth control? If conception isn't a big worry, some of the side effects from chemical contraceptives can be a very big worry.
Maybe laugh isn't the right word -- I was shaking my head in bemusement...
At any rate, I am not great at expressing myself sometimes. And my mother is one of those who don't believe that Medical Science really is... (A science, that is.) You just happened to trigger one of my MomTracks with the quotation marks, so assume I was writing to her, and we'll leave it at that.
I do hope you find the best solution for you.
Peace.
Posted by seldomseen on September 15, 2008, at 6:29:20
In reply to Re: SSRI's and Osteoporosis » Karen's World, posted by Racer on September 14, 2008, at 14:08:43
thank you for your kind words, Racer. I don't know about being smart...
Seldom.
Posted by seldomseen on September 15, 2008, at 6:43:57
In reply to Re: SSRI's and Osteoporosis, posted by Karen's World on September 14, 2008, at 16:51:35
Have you considered Evista (raloxifene)? It is indicated for prevention of osteoporosis post menopause. I don't know if it will reverse bone loss like the biphosphonates (I know a lot of women that simply can NOT tolerate them either).
It is not without risk, however.
I will be interested in your experience with calcitonin and looking forward to your post.
Take care.
Seldom
Posted by Nadezda on September 15, 2008, at 15:46:16
In reply to Re: SSRI's and Osteoporosis » Karen's World, posted by seldomseen on September 15, 2008, at 6:43:57
One other type of drug that may make people more susceptible to osteoporosis is the protein pump inhibitor given, for example, for acid reflux and other similar problems, one of them being prilosec.
I wonder how many other drugs there are that we don't even know about.
Nadezda
Posted by Karen's World on September 15, 2008, at 16:38:23
In reply to Re: SSRI's and Osteoporosis, posted by Nadezda on September 15, 2008, at 15:46:16
I don't know...but another one, for sure, is prednisone.
Posted by Karen's World on September 15, 2008, at 16:44:23
In reply to Re: SSRI's and Osteoporosis » Karen's World, posted by Racer on September 14, 2008, at 17:28:04
Thanks. My former doc probably needed to write a few more Nuva Ring prescriptions to help finance his trip to the Bahamas last year! LOL
Posted by Karen's World on September 15, 2008, at 16:46:58
In reply to Re: SSRI's and Osteoporosis » Karen's World, posted by seldomseen on September 15, 2008, at 6:43:57
Yes, I have seen the Evista commercials on TV (all the women standing around in towels. What's up with that anyway?) I'll ask my doc about it at my next appointment. The ad says that its supposed to cut the risk of breast cancer. Sounds good so far. Thanks for the input.
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