From the Guidelines
Long-term use of SSRIs, typically 10-20 years, may increase the risk of osteoporosis and potentially impact cognitive health, although the evidence is not entirely conclusive 1. When considering the long-term effects of SSRIs on cognitive health and osteoporosis, it's essential to weigh the potential risks against the benefits of treating depression.
- Cognitive health: While some studies suggest that SSRIs may cause subtle memory issues, word-finding difficulties, and emotional blunting in some patients with prolonged use, untreated depression itself can impair cognition, making it challenging to separate medication effects from the underlying condition.
- Osteoporosis risk: SSRIs appear to modestly increase fracture risk, particularly in older adults, those on higher doses, or with other risk factors, with paroxetine (Paxil) potentially having a more pronounced effect 1. Key considerations for patients on long-term SSRI therapy include:
- Bone density monitoring
- Adequate calcium and vitamin D intake
- Weight-bearing exercise
- Periodic cognitive assessments It's crucial for patients to discuss any concerns or potential medication changes with their healthcare provider, as the benefits of treating depression often outweigh the potential risks 1. In terms of preventive measures, guidelines recommend lifestyle modifications and medical therapy, including supplemental calcium, vitamin D, and bisphosphonates, to prevent or treat bone loss in patients receiving long-term steroid therapy, which may also be applicable to SSRI users 1.
From the Research
Long-term Side Effects of SSRIs on Cognitive Health
- There is limited research available on the long-term effects of SSRIs on cognitive health, specifically with prolonged use of 10-20 years 2.
- However, it is essential to note that the general health risks of long-term SSRI use are considered low, but further research is needed, particularly in special populations including youth and the elderly 2.
Long-term Side Effects of SSRIs on Osteoporosis
- Studies have consistently shown that long-term use of SSRIs is associated with an increased risk of osteoporosis and fractures 3, 4, 5, 6.
- The evidence suggests that SSRIs can have deleterious effects on bone mineral density, particularly in older adults, and may contribute to osteoporosis 3, 4, 5, 6.
- A systematic review and meta-analysis found that SSRI use was significantly associated with lower bone mineral density values, particularly in older people 6.
- Another study found that SSRI use was associated with a greater bone loss in older men, with a difference in bone mineral density similar to that seen with glucocorticoids 5.
Key Considerations for Long-term SSRI Use
- Prescribers should consider the potential risks and benefits of long-term SSRI use and periodically reassess the risk-benefit ratio of remaining on the medication 2.
- Patients who remain on SSRIs for the long-term should have periodic monitoring to assess the safety, tolerability, and efficacy of the medication, as well as to reassess the risk of osteoporosis and fractures 2, 3, 4, 5, 6.