The Effect of Depression, Generalized Anxiety, and Selective Serotonin Reuptake Inhibitors on Change in Bone Metabolism in Adolescents and Emerging Adults

Calarge, Chadi A.; Mills, James A.; Janz, Kathleen F.; Burns, Trudy L.; Schlechte, Janet A.; Coryell, William; Zemel, Babette S.

doi:10.1002/jbmr.3238

Cited by 18 publications

(10 citation statements)

References 34 publications

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“…Potent dopamine antagonists, such as risperidone, affect bone health through hyperprolactinemia, which causes hypogonadism leading to bone loss 64 . Prolactin has an inhibitory effect on osteoblasts 65 . Compared to cisgender adults, it is less clear for TNG patients already on GnRHAs or GAHT how much this specific mechanism may contribute to bone loss.…”

Section: Resultsmentioning

confidence: 99%

Psychopharmacological Considerations for Gender-Affirming Hormone Therapy

Kim

Goetz

Grieve

et al. 2023

Harv Rev Psychiatry

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The field of transgender health has grown exponentially since the early 2010s. While this increased visibility has not been without controversy, there is growing acknowledgement of the needs of transgender, nonbinary, and gender expansive (TNG) patients and the health disparities they experience compared to the cisgender population. There is also increased interest among clinicians and trainees in providing gender-affirming care in all medical specialties. This is particularly relevant in psychiatry as mental health disparities in TNG patients have been well-documented. TNG patients experience significant minority stress and higher rates of psychiatric illness, self-harm, suicidality, and psychiatric hospitalization compared to their cisgender peers. In this review, we will cover potential interactions and side effects relevant to psychiatric medication management for the three most common medication classes prescribed as part of gender-affirming hormone therapy (GAHT): gonadotropin-releasing hormone receptor agonists, estradiol, and testosterone. Although no studies directly examining the efficacy of psychiatric medications or their interactions with GAHT for TNG patients have been published yet, we have synthesized the existing literature from both cisgender and TNG patients to shed light on health care disparities seen in TNG patients. Since clinicians’ lack of comfort and familiarity with gender-affirming care contributes significantly to these disparities, we hope this narrative review will help psychiatric prescribers provide TNG patients with the same quality of care that cisgender patients receive.

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Section: Resultsmentioning

confidence: 99%

Psychopharmacological Considerations for Gender-Affirming Hormone Therapy

Kim

Goetz

Grieve

et al. 2023

Harv Rev Psychiatry

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“…Stress-induced emotional disorders, such as anxiety and depression, are closely related to bone loss [8,[11][12][13]. Denes and colleagues identified fluorescent signals in several brain regions following injection of pseudorabies virus (PRV) into the bone marrow cavity of rats, thereby proving a physical neural connection between bone and brain [33].…”

Section: Discussionmentioning

confidence: 99%

“…Chronic stress can lead to different mental disorders, manifesting as anxiety, depression, panic, and other symptoms [ 1 – 3 ]. Importantly, chronic stress-induced anxiety often causes a variety of metabolic problems, including glucose [ 4 , 5 ], lipid [ 6 , 7 ], and bone metabolism disorders [ 8 , 9 ]. In particular, abnormal bone metabolism is a common symptom of stress and anxiety [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Astrocytes in the Ventromedial Hypothalamus Involve Chronic Stress-Induced Anxiety and Bone Loss in Mice

Shao

Gao

et al. 2021

Neural Plasticity

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Chronic stress is one of the main risk factors of bone loss. While the neurons and neural circuits of the ventromedial hypothalamus (VMH) mediate bone loss induced by chronic stress, the detailed intrinsic mechanisms within the VMH nucleus still need to be explored. Astrocytes in brain regions play important roles in the regulation of metabolism and anxiety-like behavior through interactions with surrounding neurons. However, whether astrocytes in the VMH affect neuronal activity and therefore regulate chronic stress-induced anxiety and bone loss remain elusive. In this study, we found that VMH astrocytes were activated during chronic stress-induced anxiety and bone loss. Pharmacogenetic activation of the Gi and Gq pathways in VMH astrocytes reduced and increased the levels of anxiety and bone loss, respectively. Furthermore, activation of VMH astrocytes by optogenetics induced depolarization in neighboring steroidogenic factor-1 (SF-1) neurons, which was diminished by administration of N-methyl-D-aspartic acid (NMDA) receptor blocker but not by alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor blocker. These results suggest that there may be a functional “glial-neuron microcircuit” in VMH nuclei that mediates anxiety and bone loss induced by chronic stress. This study not only advances our understanding of glial cell function but also provides a potential intervention target for chronic stress-induced anxiety and bone loss therapy.

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“…12, 13 Finally, our findings may not apply to females, who formed too small a minority of our participants to be included in this analysis. Given that sex might interact with the metabolic effect of SSRIs, 56, 57 future studies should include girls as well as patients from more diverse racial and ethnic backgrounds. Furthermore, a stepwise approach is needed to determine the effect of SSRIs on growth velocity, GH activity, and include a follow up after SSRIs are discontinued as well as into adulthood to determine if the effect is reversible and whether adult height is indeed adversely impacted.…”

Section: Discussionmentioning

confidence: 99%