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Balancing Benefits and Potential Skeletal Risks of Serotonin Reuptake Inhibitors

Kenneth Saag, MD, MSc

Arch Intern Med. 2007;167(12):1231-1232.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Depression affects as many as 40% of adults older than 55 years,¹ and major depressive disorder leads to substantial disability,² with an estimated US societal cost of $83.1 billion in the year 2000.³ In the past 2 decades, second-generation antidepressants in the family of selective serotonin reuptake inhibitors (SSRIs) have vastly surpassed first-generation tricyclic antidepressants (TCAs) in the marketplace and now rank third among all drug classes in US prescription drug sales.⁴ The SSRIs have similar efficacy to TCAs in improving quality of life and decreasing mortality among depressed adults.⁴ Preference for SSRIs over TCAs has been driven by a lower risk of anticholinergic adverse effects and overdose lethality. Because of concerns about the arrhythmogenic potential of TCAs, there is a strong preference for SSRIs in older adults in whom depression commonly coincides with heart disease.⁵ Despite controversy about increased suicidality in children,⁶ SSRIs have continued . . . [Full Text of this Article]

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