Depression is one of the mental health disordersleads to major public health problems worldwide.The association between depression and reduced bone mineral density (BMD) has been reported inconsistently.However the role of depression as a risk factor for low bone mineral density (BMD) and osteoporosis is not fully understood, mainly because the relevant literature is inconsistent and because information on the mechanisms mediating brain-to-bone signals is rather scanty. Selective serotonin reuptake inhibitors (SSRIs), the first-line antidepressants, increase extracellular 5-hydroxytryptamine (5-HT) levels but have deleterious skeletal effects. The skeletal serotonergic system consists of 5-HT receptors and the 5-HT transporter (5-HTT) in osteoblasts and osteocytes. 5-HTT is a transmembrane protein targeted by SSRIs. 5-HT restrains osteoblastic activity, thus leading to bone loss.This review provides an extensive literature on markers of osteoporosis, and updated information on association between depression, antidepressants and bone loss. Furthermorethis review highlights the probable mechanisms of antidepressant drug-induced bone disease with emphasis on the side effect profile of these medications on bone metabolism thus prompting clinicians to screen patients at high risk of osteoporosis onantidepressant drugs, to help reduce the incidence of potentially avoidable fractures.
