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COMMENTS AND OPINIONS
Concerns About Bone Safety of Tricyclic Antidepressant Therapy
Wee-Shiong Lim, MBBS, MRCP;
Mark Chan, MBBS
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While the study by Diem and colleagues1 adds to a growing body of evidence regarding the possible deleterious effects of selective serotonin reuptake inhibitors (SSRIs) on bone health, their conclusion about the lack of a similar effect with tricyclic antidepressants (TCAs) may be mitigated by methodological concerns.
Of note, there are concerns that confounding by indication may have selected a TCA group that possesses different characteristics from SSRI users. In particular, the majority of TCA users in the analysis may have been prescribed TCAs for indications other than depression (eg, neuropathic pain and insomnia), a postulation corroborated by the observation that TCA users were less severely depressed and more physically impaired compared with SSRI users. This is further compounded by the exclusion of 31 subjects who reported the use of both SSRIs and TCAs, a group that is likely to comprise those with . . . [Full Text of this Article]
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RELATED LETTER
Concerns About Bone Safety of Tricyclic Antidepressant Therapy—Reply
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Arch Intern Med. 2008;168(4):436.
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