Fracture risks of antidepressants.

Antidepressants come in a variety of types, the main types being tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs) and the group of other antidepressants. Among the TCAs, only amitriptyline seems to be associated with an increased risk of fractures, which is probably linked to an increased risk of falls. SSRIs seem to be associated with an increased risk of fractures as a class effect. An early increase probably linked to falls is observed within the first 14 days of initiating a SSRI, but also a sustained small increase in the risk of fractures seems present with SSRIs. The group of other antidepressants did not seem to be systematically associated with fractures, although a small increase may be seen for some types early after initiation. The alterations in risk of fractures were small and differences between preparations limited. In the interpretation, the effect of confounding by indication should be remembered; patients with depression may have an increased risk of fractures per se.