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Taccardi D, Chiesa A, Maiorani C, Pardo A, Lombardo G, Scribante A, Sabatini S, Butera A. Periodontitis and Depressive Disorders: The Effects of Antidepressant Drugs on the Periodontium in Clinical and Preclinical Models: A Narrative Review. J Clin Med 2024; 13:4524. [PMID: 39124790 PMCID: PMC11312867 DOI: 10.3390/jcm13154524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 07/26/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: Several psychological conditions, including stress and depression, can adversely affect oral health; in fact, antidepressants, commonly used to treat depressive disorders, may have conflicting effects on the periodontal status of individuals. The aim of this review was to determine the effects of antidepressants on the periodontium. Methods: A literature search was conducted using electronic databases, Pubmed/MEDLINE, Cochrane Library, focusing on the use of antidepressants and their effects on periodontal health in animals or humans. Results: Seventeen articles have been included with the use of amitriptyline (two studies), desipramine (one study), imipramine (two studies), desvenlafaxine (one study), fluoxetine (six studies), venlafaxine (three studies) and tianeptine (two studies). One study evaluated several categories of antidepressants, such as selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), tricyclic, atypical and monoamine oxidase inhibitors (MAO). Most trials showed improvements in periodontal health, especially with fluoxetine, but also with imipramine, desipramine, desvenlafaxine and tianeptine; on the contrary, worsening of clinical periodontal indices and increased loss of alveolar bone were reported with venlafaxine. Conclusions: This review suggests that in the presence of comorbidity between periodontitis and depression, pharmacological treatment with SNRIs, SSRIs and mixed antidepressants is associated with improvement in periodontal parameters, except for venlafaxine. Healthcare professionals (especially oral and mental health professionals) should investigate proper adherence to medication therapy in patients with a history of periodontitis and depression. Further clinical trials are needed to confirm these results.
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Affiliation(s)
- Damiano Taccardi
- Unit of Dental Hygiene, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (D.T.); (A.C.); (A.S.); (A.B.)
| | - Alessandro Chiesa
- Unit of Dental Hygiene, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (D.T.); (A.C.); (A.S.); (A.B.)
| | - Carolina Maiorani
- Unit of Dental Hygiene, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (D.T.); (A.C.); (A.S.); (A.B.)
| | - Alessia Pardo
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy;
| | - Giorgio Lombardo
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy;
| | - Andrea Scribante
- Unit of Dental Hygiene, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (D.T.); (A.C.); (A.S.); (A.B.)
- Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Silvia Sabatini
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Andrea Butera
- Unit of Dental Hygiene, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (D.T.); (A.C.); (A.S.); (A.B.)
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Majeed R, Sathi KV, Patil RS, Singh N, Duseja S, Kondreddy K. Association of the Antidepressants and the Periodontal Status: An Original Research. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S215-S218. [PMID: 38595612 PMCID: PMC11000883 DOI: 10.4103/jpbs.jpbs_464_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/14/2023] [Accepted: 08/29/2023] [Indexed: 04/11/2024] Open
Abstract
Antidepressants have anti-inflammatory effects and boost immunity, and dentists should be aware. This case-control study included only those patients who consented to take part and had a ham-d score of at least 16 and a diagnosis of moderate-to-severe depression. Inclusion criteria included adults, those experiencing moderate to severe depression, taking fluoxetine or venlafaxine, and those with twenty or more teeth. Exclusion criteria included tobacco chewers, smokers, women expecting or nursing, periodontal treatment, antibiotics, anti-inflammatory medication, or vitamin/nutritional supplements. Patients who had had surgery or other therapy were excluded from the study. Three groups of patients were created: Control, venlafaxine, and fluoxetine. A periodontist assisted in the dental examination, and indices were observed. The analysis was done using Statistical Package for the Social Sciences (SPSS) version 24.0. Number, percentage, mean, and standard deviation were used to present the values. Results showed that antidepressants may be a risk factor for periodontal health, with increased periodontal parameters, and concluded that It is crucial to frequently check the periodontal health of depressed people using fluoxetine or venlafaxine since these drugs put good periodontal tissues at risk.
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Affiliation(s)
- Rizleena Majeed
- Department of Periodontology, Kannur Dental College, Anjarakandy, Kerala, India
| | - Krishna V. Sathi
- BDS, Government Dental College and Hospital, Hyderabad, Telangana, India
| | - Ruthika S. Patil
- Prosthodontics, Research Student Worker, Kornberg School of Dentistry, Temple University, Philadelphia, PA, United States
| | - Neetu Singh
- BDS Dentist, Dr. Neetu’s Dental Clinic, Noida, Uttar Pradesh, India
| | - Shilpa Duseja
- Department of Periodontology, Narsinhbhai Patel Dental College and Hospital, Sankalchand Patel University, Visnagar, Gujarat, India
| | - Kameswari Kondreddy
- Department of Periodontics, Faculty of Dentistry, AIMST University, Semeling, Bedong, Kedah, Malaysia
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Hakam AE, Duarte PM, Mbadu MP, Aukhil I, da Silva HDP, Chang J. Association of different antidepressant classes with clinical attachment level and alveolar bone loss in patients with periodontitis: A retrospective study. J Periodontal Res 2021; 57:75-84. [PMID: 34622954 DOI: 10.1111/jre.12939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/25/2021] [Accepted: 09/15/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Our study aimed to determine the relationship of antidepressant medicine use with periodontal diseases, exploring the association of different pharmacological classes of antidepressant with observations of clinical attachment loss (CAL) and alveolar bone level (BL) in patients with periodontitis. BACKGROUND Existing evidence on the impact of antidepressant medication on periodontal tissues has focused on some classes only and is still unclear. Therefore, this retrospective study evaluated the association of different antidepressant classes with clinical attachment loss (CAL) and alveolar bone level (BL). METHODS This study was carried out in a population of patients aged ≥ 30 years old with periodontitis who sought treatment at the University of Florida from 2014 to 2018. The following variables were obtained from patients' records; usage of antidepressant medications and their pharmacological classes (selective serotonin reuptake inhibitors [SSRI], serotonin-norepinephrine reuptake inhibitors [SNRI], tricyclic, atypical, and monoamine oxidase inhibitors [MAO]), age, gender, smoking habit, mild systemic diseases, CAL, and cement-enamel junction (CEJ) and alveolar bone crest (BC) distance, defined as BL, in the Ramfjord index teeth. RESULTS Five hundred and eighty-two periodontitis patients were evaluated, of which 113 (19.4%) were antidepressant users. Antidepressant users exhibited significantly lower BL and fewer sites with severe CAL (≥5 mm), than non-users (p < .05). Among all single-class antidepressant users, the SSRI users showed significantly less CAL and lower BL than non-users (p < .05). Patients taking combinations of the different classes of antidepressants also showed better CAL and BL than non-users. Generalized linear models, including variables such as gender, age, systemic diseases, and smoking, demonstrated that antidepressant users were more likely to have lower mean BL and fewer sites with severe bone loss (i.e. BL > 3 and >5 mm) than non-users (p < .05). CONCLUSIONS Antidepressant medications were associated with higher alveolar bone level and less clinical attachment loss in patients with periodontitis. When the different classes of antidepressants were analyzed individually, only the SSRI class users and the multiple-class users showed significantly less periodontal breakdown than non-users.
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Affiliation(s)
- Abeer Essam Hakam
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Poliana Mendes Duarte
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Marcia Phemba Mbadu
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Ikramuddin Aukhil
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | | | - Jia Chang
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, USA
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Hakam AE, Vila G, Duarte PM, Mbadu MP, Ai Angary DS, Shuwaikan H, Aukhil I, Neiva R, da Silva HDP, Chang J. Effects of different antidepressant classes on dental implant failure: A retrospective clinical study. J Periodontol 2020; 92:196-204. [PMID: 32725908 DOI: 10.1002/jper.19-0714] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/25/2020] [Accepted: 04/26/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Previous studies have suggested an association between taking antidepressants and dental implant failure. This study aimed to investigate the association of different antidepressant classes with dental implant failure. METHODS This retrospective study included patients that received dental implants at the University of Florida from 2011 to 2016. The variables of implant failure, antidepressant use and classes (selective serotonin reuptake inhibitors [SSRI], serotonin-norepinephrine reuptake inhibitors [SNRI], tricyclic antidepressants [TCA], atypical antidepressants [AA], and monoamine oxidase inhibitors [MAOI]), age, sex, smoking, mild systemic diseases, and implant location were obtained from patients' records. Odds ratio (OR) and confidence interval (CI) of implant failure in patients taking different antidepressant classes, in relationship to non-antidepressant users, were estimated, and the influence of multiple variables on implant failure were investigated. RESULTS A total of 771 patients and 1,820 implants were evaluated. The statistically significant predictors for implant failure included smoking (OR = 5.221), use of antidepressants (OR = 4.285), posterior maxilla location (OR = 2.911), mild systemic disease (OR = 2.648), and age (OR = 1.037) (P <0.05). The frequency of implant failure was 33.3% in TCA users, 31.3% in SNRI users, 6.3% in SSRI users, 5.2% in Atypical antidepressant users, and 3.9% in non-users. Significant associations were observed between the use of SNRI (OR: 11.07; 95% CI: 3.265 to 33.82) and TCA (OR: 12.16; 95% CI: 1.503 to 71.58) and implant failure (P <0.05). CONCLUSIONS Users of antidepressants were at higher risk of implant failure than non-users. Patients taking SNRI and TCA were at the highest risk of implant loss, when compared with non-users. Conclusions about TCA, however, are based on a limited number of cases.
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Affiliation(s)
- Abeer Essam Hakam
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Gabriela Vila
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Poliana Mendes Duarte
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Marcia Phemba Mbadu
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | | | - Hotoun Shuwaikan
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Ikramuddin Aukhil
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Rodrigo Neiva
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | | | - Jia Chang
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA
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Bey A, Ahmad SS, Azmi SA, Ahmed S. Effect of antidepressants on various periodontal parameters: A case-control study. J Indian Soc Periodontol 2020; 24:122-126. [PMID: 32189839 PMCID: PMC7069119 DOI: 10.4103/jisp.jisp_210_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 10/26/2019] [Accepted: 11/28/2019] [Indexed: 11/21/2022] Open
Abstract
Background: Various medications are used in the treatment of chronic systemic diseases that affect the periodontium. Antidepressants in mentally depressed patients are prescribed for a long term, but their effect on the periodontium has not been studied adequately. A case–control study was conducted to know the effect of two commonly prescribed antidepressants – venlafaxine (serotonin–norepinephrine reuptake inhibitor [SNRI]) and fluoxetine (selective serotonin reuptake inhibitor [SSRI]). These drugs have been shown to possess anti-inflammatory properties but do not protect the periodontium from insults caused by these medications, which are significantly associated with the presence of destruction of the periodontium. The aim of this study was to clinically evaluate the effect of antidepressants on various periodontal parameters. Materials and Methods: The study sample consisted of 182 depressed patients divided into three study groups: Group I – the control group diagnosed as depressed on the first visit, Group II – depressed patients taking fluoxetine 20 mg/day, and Group III – patients taking venlafaxine 75 mg/day. Patients in Groups II and III were on isolated antidepressant medication at least for a period of 3 or more months. Mental depression in patients was assessed with the Patient Health Questionnaire-based Hamilton Depression Rating Scale with scoring of ≤16. All the depressed patients were assessed for periodontal health on the basis of the clinical periodontal parameters. Results: The commonly prescribed antidepressants such as fluoxetine and venlafaxine do not protect the periodontium from destruction in spite of possessing anti-inflammatory properties; therefore, these drugs may be considered as a risk factor for periodontal health. The comparative periodontal indices on nonusers of antidepressants or control group (Group I), users of SSRI (fluoxetine) (Group II), and users of antidepressants-SNRI (venlafaxine) (Group III) showed increased periodontal parameters, especially debris index (DI), calculus index (CI), gingival index (GI), periodontal pocket depth (PD), and loss in clinical attachment level. There was no significant difference for CI and GI, probing PD, and clinical attachment levels except DI which was significantly different (P ≤ 0.001). Conclusion: The depressed patients receiving fluoxetine or venlafaxine should be regularly evaluated for periodontal health status as these drugs are risk factors for normal periodontal tissues. Further, these medications did not protect the periodontium from periodontal inflammation, although possessing anti-inflammatory properties.
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Affiliation(s)
- Afshan Bey
- Department of Periodontics, Dr. Z.A. Dental College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Syed Saeed Ahmad
- Department of Oral and Maxillofacial Surgery, Dr. Z.A. Dental College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Suhail Ahmed Azmi
- Department of Psychiatry, J.N. Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Sameena Ahmed
- Department of Community Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Venlafaxine alleviates complete Freund's adjuvant-induced arthritis in rats: Modulation of STAT-3/IL-17/RANKL axis. Life Sci 2019; 226:68-76. [PMID: 30928406 DOI: 10.1016/j.lfs.2019.03.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/11/2019] [Accepted: 03/25/2019] [Indexed: 02/08/2023]
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Gunepin M, Derache F, Trousselard M, Salsou B, Risso JJ. Impact of chronic stress on periodontal health. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2018. [DOI: 10.1051/mbcb/2017028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Periodontal diseases are caused by pathogenic microorganisms that induce increases in of local and systemic proinflammatory cytokines, resulting in periodontal damage. The onset and evolution of periodontal diseases are influenced by many local and systemic risk factors. Educational objective: In this article, we aim to review the results of the research on the impact of chronic stress on the occurrence, development, and response to periodontal disease treatments and on the pathophysiological mechanisms of periodontal disease. Conclusion: Chronic stress has a negative impact on the occurrence, development, and response to the treatment of periodontal disease via indirect actions on the periodontium. This can result from behavioral changes caused by stress (poor dental hygiene, smoking, etc.) and a direct neuroimmunoendocrinological action related to the consequences (particularly immunological) of the secretion of certain chemicals (e.g., cortisol) induced by the activation of the hypothalamus and the autonomic nervous system in response to stress. These factors necessitate multidisciplinary management (e.g., physician, oral surgeon, and psychologist) of patients to identify subjects with chronic stress and to employ countermeasures to decrease the impact of stress on the periodontium.
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Pan J, Jiang Q, Guan H, He J, Li B. Therapeutic effects of 3,3′-diindolylmethane on the alveolar bone in mice with experimentally induced periodontitis. BIOTECHNOL BIOTEC EQ 2018. [DOI: 10.1080/13102818.2018.1438853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jingjing Pan
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
- Guangdong General Hospital Zhuhai Hospital, Zhuhai Golden Bay Center Hospital, Zhuhai, China
| | - Qianzhou Jiang
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - Hongbing Guan
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - Jinquan He
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - Baishun Li
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
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Bhatia A, Sharma RK, Tewari S, Narula SC, Khurana H. Periodontal status in chronic periodontitis depressed patients on desvenlafaxine: An observational study. J Indian Soc Periodontol 2018; 22:442-446. [PMID: 30210195 PMCID: PMC6128120 DOI: 10.4103/jisp.jisp_219_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: A wide variety of drugs have the potential to affect immune and inflammatory responses of periodontium. A class of antidepressant drug, selective serotonin and norepinephrine reuptake inhibitors, has shown anti-inflammatory function. The aim of the present study is to explore the effect of desvenlafaxine on clinical periodontal parameters in patients with chronic periodontitis. Materials and Methods: The patients were divided into two groups as follows: test group (n = 63) comprised of participants on 50 mg once-daily dose of desvenlafaxine for ≥2 months and control group (n = 72) included participants who were yet to be prescribed medication for depression. Periodontal parameters of both the groups were analyzed and compared statistically. Results: Participants taking desvenlafaxine revealed lower values of periodontal parameters as compared to those in control group. The number of pockets with greater depth and clinical attachment loss was greater in control group. Conclusion: In our study, patients on desvenlafaxine were associated with less pocket depth and bleeding on probing.
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Affiliation(s)
- Anu Bhatia
- Division of Periodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Rajinder Kumar Sharma
- Department of Periodontics and Oral Implantology, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Shikha Tewari
- Department of Periodontics and Oral Implantology, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Satish Chander Narula
- Department of Periodontics and Oral Implantology, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Hitesh Khurana
- Department of Psychiatry, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India
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Muniz FWMG, Melo IM, Rösing CK, de Andrade GM, Martins RS, Moreira MMSM, Carvalho RDS. Use of antidepressive agents as a possibility in the management of periodontal diseases: A systematic review of experimental studies. ACTA ACUST UNITED AC 2017; 9. [PMID: 28862386 DOI: 10.1111/jicd.12291] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/01/2017] [Indexed: 11/30/2022]
Abstract
Antidepressant agents have anti-inflammatory functions that could be interesting as adjuvants in periodontal therapy. The aim of the present study was to analyze the effect of antidepressive drugs in the management of periodontal disease. The MEDLINE, Scopus, Embase, LILACS, and SciELO databases were searched. To be included, the studies had to be experimental studies; randomized, controlled; double-blinded; or blinded studies. A total of 565 articles were initially searched, of which five were selected for the systematic review. All studies used rats, and three different drugs were evaluated: tianeptine, venlafaxine, and fluoxetine. Two of these studies evaluated the effect of antidepressive agents in rats submitted to both ligature-induced periodontitis and depression models, showing that depressive rats had greater alveolar bone loss (ABL). Only the venlafaxine study was not able to find any significant ABL reduction in the group that used this antidepressive drug. The other four studies showed statistically-significant differences, favoring the group with the antidepressant agent. Treatments that are able to modulate the brain-neuroendocrine-immune system could be used as an adjuvant to periodontal disease management. However, studies on humans and animals are scarce, limiting the conclusion of a positive effect in the present systematic review.
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Affiliation(s)
| | - Iracema Matos Melo
- Department of Periodontology, Federal University of Ceará, Sobral, Brazil
| | | | - Geanne Matos de Andrade
- Department of Physiology and Pharmacology, Medicine School, Federal University of Ceará, Fortaleza, Brazil
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Impact of post-traumatic stress disorder on oral health. J Affect Disord 2017; 219:126-132. [PMID: 28549330 DOI: 10.1016/j.jad.2017.05.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 05/05/2017] [Accepted: 05/19/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The stress experienced as an intense and traumatic event can increase the odds of orofacial pain, affect the biomechanics of masticatory system and compromise the periodontal health. This study was conducted to investigate the impact of post-traumatic stress disorder (PTSD) on oral health. METHODS A case-control study with a convenience sample was designed. Probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing, and plaque were recorded at 6 sites per tooth. A visual analog scale (VAS) was used to evaluate the pain after probing. The Research Diagnostic Criteria for Temporomandibular Disorders Axis II (RDC/TMD Axis II) and Structured Clinical Interview (DSM-IV) were also applied. The final sample comprised 38 PTSD patients and 38 controls. RESULTS Patients with PTSD had a higher degree of chronic pain, more depression and nonspecific physical symptoms (including and excluding pain) compared with the control group (Fisher exact test p < 0.001, and Chi-squared test, p < 0.001, < 0.001, < 0.001, respectively). Patients with PTSD also had more pain after periodontal probing compared with controls (Mann-Whitney, p = 0.037). The prevalence of sites with CAL or PPD ≥ 4, ≥ 5, ≥ 6 were not different between the groups. Age was associated with moderate periodontitis (multivariable logistic regression model, OR = 3.33, 95% CI = 1.03-10.75, p = 0.04). LIMITATION The severity of PTSD precluded an ample sample size. CONCLUSIONS Patients with PTSD presented a worse RDC/TMD Axis II profile, more pain after periodontal probing, and no difference related to periodontal clinical parameters. More studies are needed to confirm these findings.
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Yadav NK, Nanda S, Sharma G, Katare OP. Systematically Optimized Ketoprofen-Loaded Novel Proniosomal Formulation for Periodontitis: In Vitro Characterization and In Vivo Pharmacodynamic Evaluation. AAPS PharmSciTech 2017; 18:1863-1880. [PMID: 27844417 DOI: 10.1208/s12249-016-0665-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 11/04/2016] [Indexed: 11/30/2022] Open
Abstract
Various preclinical/clinical studies support the effectiveness of ketoprofen in periodontitis; however, the literature reveals that novel delivery systems have been less explored for the drug in periodontitis. The current investigation aims to explore the potential of a pro-vesicular approach-based proniosomal drug delivery of ketoprofen for its effectiveness and validation in experimental periodontal disease (EPD). Formulations were developed using I-optimal mixture design. Developed formulations were characterized for entrapment efficiency, vesicle size, and in vitro drug release. Selected proniosomal gels were evaluated for mucoadhesiveness, ex vivo drug permeation, and retention studies. Optimized proniosomal gel was evaluated for surface morphology, rheological behavior, texture studies, and pharmacodynamic activity in EPD. The results showed that ketoprofen-loaded proniosomal formulations formed a mucoadhesive hydrogel comprising spherical and flexible vesicles. Viscosity and texture studies showed good adhesion and smoothness, which are desired for enhanced permeation. The disease condition was improved with preserved bone resorption process, that too with intact cementum vis-à-vis marketed gel formulation, when evaluated in the EPD model. The results lead to the conclusion that proniosomes can act as a promising carrier and can be effectively used for improved ketoprofen delivery in periodontal pockets.
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Oliveira GJPL, Paula LGF, Souza JAC, Spin-Neto R, Stavropoulos A, Marcantonio RAC. Effect of avocado/soybean unsaponifiables on ligature-induced bone loss and bone repair after ligature removal in rats. J Periodontal Res 2016; 51:332-41. [PMID: 26248485 DOI: 10.1111/jre.12312] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to evaluate the effects of administration of avocado/soybean unsaponifiable (ASU), a drug that is commonly used in the treatment of rheumatoid arthritis, on ligature-induced bone loss and bone repair after ligature removal in rats. MATERIAL AND METHODS Eighty-four rats were randomly assigned to four groups of equal size and received a daily gavage of either sterile saline [control (CTR)] or ASU (0.6 mg/kg), starting 7 d before (ASU/-7), on the day of (ASU/0) or 7 d after (ASU/+7) periodontitis induction. Periodontitis was induced by placing silk ligatures into the gingival sulcus of the second maxillary molars for 7 d; after 7 d, the ligatures were removed. Seven rats from each group were sacrificed, 7, 15 or 30 d after ligature removal. Bone resorption was evaluated by histomorphometry and micro-computed tomography (micro-CT). Immunohistochemistry was used to evaluate the expression of TRAP, RANKL and alkaline phosphatase (ALP), and quantitative PCR (qPCR) was used to evaluate the levels of interleukin-1beta (Il1β), tumor necrosis factor alpha (Tnfα), interleukin-6 (Il-6), Rankl and Alp. Statistical analysis was performed using the Shapiro-Wilk test, ANOVA and Tukey's test for normal data, and using the Kruskall-Wallis and Dunnet's tests for non-normal data (p < 0.05). RESULTS Histomorphometry and micro-CT analysis showed greater bone resorption in the CTR group than in the ASU/0 (15 d) and ASU/+7 (7 and 15 d) groups. The CTR group also presented with a higher expression of TRAP (15 and 30 d) and RANKL (7 and 15 d) compared with ASU/0 and ASU/+7 groups. Similarly, qPCR analysis showed higher levels of Rankl and Il1β mRNAs, and lower levels of Alp mRNA, in the CTR group compared with all other groups (for all periods). CONCLUSION ASU exhibited a positive effect on bone repair following ligature-induced periodontitis in rats.
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Affiliation(s)
- G J P L Oliveira
- Section of Periodontology, Department of Diagnosis and Surgery, Araraquara School of Dentistry, University Estadual Paulista - UNESP, Araraquara, SP, Brazil
| | - L G F Paula
- Section of Periodontology, Department of Diagnosis and Surgery, Araraquara School of Dentistry, University Estadual Paulista - UNESP, Araraquara, SP, Brazil
| | - J A C Souza
- Section of Periodontology, Department of Diagnosis and Surgery, Araraquara School of Dentistry, University Estadual Paulista - UNESP, Araraquara, SP, Brazil
| | - R Spin-Neto
- Section of Oral Radiology, Department of Dentistry, Aarhus University, Aarhus, Denmark
| | - A Stavropoulos
- Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - R A C Marcantonio
- Section of Periodontology, Department of Diagnosis and Surgery, Araraquara School of Dentistry, University Estadual Paulista - UNESP, Araraquara, SP, Brazil
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Lima GMG, Corazza BJM, Moraes RM, de Oliveira FE, de Oliveira LD, Franco GCN, Perrien DS, Elefteriou F, Anbinder AL. The effect of an inhibitor of gut serotonin (LP533401) during the induction of periodontal disease. J Periodontal Res 2016; 51:661-8. [PMID: 26740292 DOI: 10.1111/jre.12346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE LP533401 is an inhibitor of tryptophan hydroxylase 1, which regulates serotonin production in the gut. Previous work indicates that LP533401 has an anabolic effect in bone. Thus, we hypothesized that inhibition of gut serotonin production may modulate the host response in periodontal disease. In this study, we aimed to analyze the effects of LP533401 in a rat periodontitis model to evaluate the role of gut serotonin in periodontitis pathophysiology. MATERIAL AND METHODS Twenty-four rats were divided into three groups: treated group (T: ligature-induced periodontal disease and LP533401, 25 mg/kg/d) by gavage; ligature group (L: ligature-induced periodontal disease only); and control group (C: without ligature-induced periodontal disease). After 28 d, radiographic alveolar bone support was measured on digital radiographs, and alveolar bone volume fraction, tissue mineral density and trabeculae characteristics were quantified by microcomputed tomography in the right hemi-mandible. Left hemi-mandibles were decalcified and alveolar bone loss, attachment loss and area of collagen in the gingiva were histologically analyzed. RESULTS Significant difference between the L and C groups was found, confirming that periodontal disease was induced. We observed no difference between the T and L groups regarding alveolar bone destruction and area of collagen. CONCLUSION LP533401 (25 mg/kg/d) for 28 d does not prevent bone loss and does not modulate host response in a rat model of induced periodontal disease.
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Affiliation(s)
- G M G Lima
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology of São José dos Campos, Univ Estadual Paulista - UNESP, São José dos Campos, SP, Brazil
| | - B J M Corazza
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology of São José dos Campos, Univ Estadual Paulista - UNESP, São José dos Campos, SP, Brazil
| | - R M Moraes
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology of São José dos Campos, Univ Estadual Paulista - UNESP, São José dos Campos, SP, Brazil
| | - F E de Oliveira
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology of São José dos Campos, Univ Estadual Paulista - UNESP, São José dos Campos, SP, Brazil
| | - L D de Oliveira
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology of São José dos Campos, Univ Estadual Paulista - UNESP, São José dos Campos, SP, Brazil
| | - G C N Franco
- Department of General Biology, State University of Ponta Grossa - UEPG, Ponta Grossa, Paraná, Brazil
| | - D S Perrien
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Orthopedic Surgery & Rehabilitation and Vanderbilt University Institute of Imaging Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA
| | - F Elefteriou
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA.,Departments of Medicine, Pharmacology and Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - A L Anbinder
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology of São José dos Campos, Univ Estadual Paulista - UNESP, São José dos Campos, SP, Brazil
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Li X, Wu X, Ma Y, Hao Z, Chen S, Fu T, Chen H, Wang H. Oral administration of 5-hydroxytryptophan aggravated periodontitis-induced alveolar bone loss in rats. Arch Oral Biol 2015; 60:789-98. [PMID: 25766472 DOI: 10.1016/j.archoralbio.2015.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 11/26/2014] [Accepted: 01/31/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE 5-Hydroxytryptophan (5-HTP) is the precursor of serotonin and 5-HTP has been widely used as a dietary supplement to raise serotonin level. Serotonin has recently been discovered to be a novel and important player in bone metabolism. As peripheral serotonin negatively regulates bone, the regular take of 5-HTP may affect the alveolar bone metabolism and therefore influence the alveolar bone loss induced by periodontitis. The aim of this study was to investigate the effect of 5-HTP on alveolar bone destruction in periodontitis. DESIGN Male Sprague-Dawley rats were randomly divided into the following four groups: (1) the control group (without ligature); (2) the 5-HTP group (5-HTP at 25 mg/kg/day without ligature); (3) the L group (ligature+saline placebo); and (4) the L+5-HTP group (ligature+5-HTP at 25 mg/kg/day). Serum serotonin levels were determined by ELISA. The alveolar bones were evaluated with micro-computed tomography and histology. Tartrate-resistant acid phosphatase staining was used to assess osteoclastogenesis. The receptor activator of NF-kB ligand (RANKL) and osteoprotegerin (OPG) expression in the periodontium as well as the interleukin-6 positive osteocytes were analysed immunohistochemically. RESULTS 5-HTP significantly increased serum serotonin levels. In rats with experimental periodontitis, 5-HTP increased alveolar bone resorption and worsened the micro-structural destruction of the alveolar bone. 5-HTP also stimulated osteoclastogenesis and increased RANKL/OPG ratio and the number of IL-6 positive osteocytes. However, 5-HTP treatment alone did not cause alveolar bone loss in healthy rats. CONCLUSION The present study showed that 5-HTP aggravated alveolar bone loss, deteriorated alveolar bone micro-structure in the presence of periodontitis, which suggests 5-HTP administration may increase the severity of periodontitis.
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Affiliation(s)
- Xianxian Li
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, PR China; West China College of Stomatology, Sichuan University, Chengdu 610041, PR China
| | - Xiangnan Wu
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, PR China; West China College of Stomatology, Sichuan University, Chengdu 610041, PR China
| | - Yuanyuan Ma
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, PR China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, PR China
| | - Zhichao Hao
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, PR China; West China College of Stomatology, Sichuan University, Chengdu 610041, PR China
| | - Shenyuan Chen
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing 401147, PR China; The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing 401147, PR China
| | - Taozi Fu
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, PR China; West China College of Stomatology, Sichuan University, Chengdu 610041, PR China
| | - Helin Chen
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, PR China; West China College of Stomatology, Sichuan University, Chengdu 610041, PR China
| | - Hang Wang
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, PR China; West China College of Stomatology, Sichuan University, Chengdu 610041, PR China.
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16
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Lu H, Xu M, Wang F, Liu S, Gu J, Lin S. Chronic stress enhances progression of periodontitis via α1-adrenergic signaling: a potential target for periodontal disease therapy. Exp Mol Med 2014; 46:e118. [PMID: 25323788 PMCID: PMC4221694 DOI: 10.1038/emm.2014.65] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 08/01/2014] [Accepted: 08/13/2014] [Indexed: 12/22/2022] Open
Abstract
This study assessed the roles of chronic stress (CS) in the stimulation of the sympathetic nervous system and explored the underlying mechanisms of periodontitis. Using an animal model of periodontitis and CS, the expression of tyrosine hydroxylase (TH) and the protein levels of the α1-adrenergic receptor (α1-AR) and β2-adrenergic receptor (β2-AR) were assessed. Furthermore, human periodontal ligament fibroblasts (HPDLFs) were stimulated with lipopolysaccharide (LPS) to mimic the process of inflammation. The proliferation of the HPDLFs and the expression of α1-AR and β2-AR were assessed. The inflammatory-related cytokines interleukin (IL)-1β, IL-6 and IL-8 were detected after pretreatment with the α1/β2-AR blockers phentolamine/propranolol, both in vitro and in vivo. Results show that periodontitis under CS conditions enhanced the expression of TH, α1-AR and β2-AR. Phentolamine significantly reduced the inflammatory cytokine levels. Furthermore, we observed a marked decrease in HPDLF proliferation and the increased expression of α1-ARfollowing LPS pretreatment. Pretreatment with phentolamine dramatically ameliorated LPS-inhibited cell proliferation. In addition, the blocking of α1-ARsignaling also hindered the upregulation of the inflammatory-related cytokines IL-1β, IL-6 and IL-8. These results suggest that CS can significantly enhance the pathological progression of periodontitis by an α1-adrenergic signaling-mediated inflammatory response. We have identified a potential therapeutic target for the treatment of periodontal disease, particularly in those patients suffering from concurrent CS.
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Affiliation(s)
- Huaixiu Lu
- Department of Stomatology, Navy General Hospital, Beijing, China
| | - Minguang Xu
- Department of Medical Engineering, The Second Artillery General Hospital of PLA, Beijing, China
| | - Feng Wang
- Department of Stomatology, Navy General Hospital, Beijing, China
| | - Shisen Liu
- Department of Stomatology, Navy General Hospital, Beijing, China
| | - Jing Gu
- Department of Stomatology, Navy General Hospital, Beijing, China
| | - Songshan Lin
- Department of Stomatology, Navy General Hospital, Beijing, China
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de Araújo AA, Varela H, Brito GADC, de Medeiros CACX, Araújo LDS, do Nascimento JHO, de Araújo Júnior RF. Azilsartan increases levels of IL-10, down-regulates MMP-2, MMP-9, RANKL/RANK, Cathepsin K and up-regulates OPG in an experimental periodontitis model. PLoS One 2014; 9:e96750. [PMID: 24819928 PMCID: PMC4018354 DOI: 10.1371/journal.pone.0096750] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/10/2014] [Indexed: 01/17/2023] Open
Abstract
Aims The aim of this study was to evaluate the effects of azilsartan (AZT) on bone loss, inflammation, and the expression of matrix metallo proteinases (MMPs), receptor activator of nuclear factor κB ligand (RANKL), receptor activator of nuclear factor κB (RANK), osteoprotegerin (OPG), cyclooxygenase-2 (COX-2), and cathepsin K in periodontal tissue in a rat model of ligature-induced periodontitis. Materials and Methods Male Wistar albino rats were randomly divided into 5 groups of 10 rats each: (1) nonligated, water; (2) ligated, water; (3) ligated, 1 mg/kg AZT; (4) ligated, 5 mg/kg AZT; and (5) ligated, 10 mg/kg AZT. All groups were treated with saline or AZT for 10 days. Periodontal tissues were analyzed by histopathology and immunohistochemical detection of MMP-2, MMP-9, COX-2, RANKL, RANK, OPG, and cathepsin K. Levels of IL-1β, IL-10, TNF-α, myeloperoxidase (MPO), and glutathione (GSH) were determined by ELISA. Results Treatment with 5 mg/kg AZT resulted in reduced MPO (p<0.05) and IL-1β (p<0.05), increased levels of IL-10 (p<0.05), and reduced expression of MMP-2, MMP-9, COX-2, RANK, RANKL, cathepsin K, and increased expression of OPG. Conclusions These findings reveal that AZT increases anti-inflammatory cytokines and GSH and decreases bone loss in ligature-induced periodontitis in rats.
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Affiliation(s)
- Aurigena Antunes de Araújo
- Post Graduation Program Public Health/Post Graduation Program in Pharmaceutical Science/Department of Biophysics and Pharmacology,UFRN, Natal, Rio Grande do Norte, Brazil
- * E-mail:
| | - Hugo Varela
- Post Graduation Program Public Health/Department of Dentistry, UFRN, Natal, Rio Grande do Norte, Brazil
| | | | | | | | | | - Raimundo Fernandes de Araújo Júnior
- Post Graduation Program in Functional and Structural Biology/Post Graduation Program Health Science/Department of Morphology, UFRN, Natal, Rio Grande do Norte, Brazil
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18
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Alveolar bone loss associated to periodontal disease in lead intoxicated rats under environmental hypoxia. Arch Oral Biol 2013; 58:1407-14. [DOI: 10.1016/j.archoralbio.2013.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 06/11/2013] [Accepted: 06/12/2013] [Indexed: 01/11/2023]
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Galli C, Macaluso G, Passeri G. Serotonin: a novel bone mass controller may have implications for alveolar bone. J Negat Results Biomed 2013; 12:12. [PMID: 23964727 PMCID: PMC3766083 DOI: 10.1186/1477-5751-12-12] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 04/23/2013] [Indexed: 12/21/2022] Open
Abstract
As recent studies highlight the importance of alternative mechanisms in the control of bone turnover, new therapeutic approaches can be envisaged for bone diseases and periodontitis-induced bone loss. Recently, it has been shown that Fluoxetine and Venlafaxine, serotonin re-uptake inhibitors commonly used as antidepressants, can positively or negatively affect bone loss in rat models of induced periodontitis. Serotonin is a neurotransmitter that can be found within specific nuclei of the central nervous system, but can also be produced in the gut and be sequestered inside platelet granules. Although it is known to be mainly involved in the control of mood, sleep, and intestinal physiology, recent evidence has pointed at far reaching effects on bone metabolism, as a mediator of the effects of Lrp5, a membrane receptor commonly associated with Wnt canonical signaling and osteoblast differentiation. Deletion of Lrp5 in mice lead to increased expression of Tryptophan Hydroxylase 1, the gut isoform of the enzyme required for serotonin synthesis, thus increasing serum levels of serotonin. Serotonin, in turn, could bind to HTR1B receptors on osteoblasts and stop their proliferation by activating PKA and CREB. Although different groups have reported controversial results on the existence of an Lrp5-serotonin axis and the action of serotonin in bone remodeling, there is convincing evidence that serotonin modulators such as SSRIs can affect bone turnover. Consequently, the effects of this drug family on periodontal physiology should be thoroughly explored.
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Affiliation(s)
- Carlo Galli
- Dep, Biomedicine, Biotechnology and Translational Sciences, University of Parma, Via Gramsci 14, Parma 43126, Italy.
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Araújo AA, Lopes de Souza G, Souza TO, de Castro Brito GA, Sabóia Aragão K, Xavier de Medeiros CA, Lourenço Y, do Socorro Costa Feitosa Alves M, Fernandes de Araújo R. Olmesartan decreases IL-1β and TNF-α levels; downregulates MMP-2, MMP-9, COX-2, and RANKL; and upregulates OPG in experimental periodontitis. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2013; 386:875-84. [DOI: 10.1007/s00210-013-0886-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 05/26/2013] [Indexed: 10/26/2022]
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Rizzoli R, Cooper C, Reginster JY, Abrahamsen B, Adachi JD, Brandi ML, Bruyère O, Compston J, Ducy P, Ferrari S, Harvey NC, Kanis JA, Karsenty G, Laslop A, Rabenda V, Vestergaard P. Antidepressant medications and osteoporosis. Bone 2012; 51:606-13. [PMID: 22659406 DOI: 10.1016/j.bone.2012.05.018] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 05/23/2012] [Accepted: 05/25/2012] [Indexed: 11/16/2022]
Abstract
Use of antidepressant medications that act on the serotonin system has been linked to detrimental impacts on bone mineral density (BMD), and to osteoporosis. This article reviews current evidence for such effects, and identifies themes for future research. Serotonin receptors are found in all major types of bone cell (osteoblasts, osteocytes, and osteoclasts), indicating an important role of the neuroendocrine system in bone. Observational studies indicate a complex relationship between depression, antidepressants, and fracture. First, the presence of depression itself increases fracture risk, in relation with decreased BMD and an increase in falls. A range of aspects of depression may operate, including behavioral factors (e.g., smoking and nutrition), biological changes, and confounders (e.g., comorbidities and concomitant medications). A substantial proportion of depressed patients receive antidepressants, mostly selective serotonin reuptake inhibitors (SSRIs). Some of these have been linked to decreased BMD (SSRIs) and increased fracture risk (SSRIs and tricyclic agents). Current use of SSRIs and tricyclics increases fracture risk by as much as twofold versus nonusers, even after adjustment for potential confounders. While there is a dose-response relationship for SSRIs, the effect does not appear to be homogeneous across the whole class of drugs and may be linked to affinity for the serotonin transporter system. The increase in risk is the greatest in the early stages of treatment, with a dramatic increase after initiation, reaching a peak within 1 month for tricyclics and 8 months for SSRIs. Treatment-associated increased risk diminishes towards baseline in the year following discontinuation. The body of evidence suggests that SSRIs should be considered in the list of medications that are risk factors for osteoporotic fractures.
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Affiliation(s)
- R Rizzoli
- Division of Bone Diseases, Department of Medical Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
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