Understanding the Impact of Depression

The National Institute of Mental Health (NIMH) has just launched a new study of women ages 21 to 45 who are suffering from major depression to find out whether low bone mass is related to depression or stress hormones, such as cortisol.

During a 12-month period, NIMH researchers will monitor bone loss and the effects of depression and stress on physical health. Participants will receive a psychological evaluation, a bone mineral density test, and measurements of stress hormones.

In a review of published research, NIMH-funded scientists found a strong association between depression and osteoporosis. The literature suggests that depression may be a significant risk factor for osteoporosis, a progressive decrease in bone density that makes bones fragile and more likely to break. Low bone mineral density (BMD), a major risk factor for fracture, is more common in depressed people than in the general population.

"Using different data, all of the studies point to the same conclusion," said NIMH researcher Dr. Giovanni Cizza and colleagues. "Depression is not only a disease of the brain, but it also has long-term consequences for other medical conditions, such as osteoporosis."

A summary of the findings was published in the journal Trends in Endocrinology & Metabolism.

Both the clinical trial and research review underscore the seriousness of depression, a treatable illness that affects 5 to 9 percent of women and 1 to 2 percent of men. Depression symptoms include loss of interest or pleasure in activities that were once enjoyed, including sex; fatigue, decreased energy; difficulty concentrating, remembering, making decisions; insomnia, early-morning awakening, or oversleeping; appetite and weight loss or overeating and weight gain; thoughts of death or suicide; suicide attempts; restlessness, irritability; and persistent symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain.

Although its causes are unclear, major depression is associated with hormonal abnormalities that can lead to changes in tissue, such as bone. Research suggests that higher cortisol levels, often found in depressed patients, may contribute to bone loss and changes in body composition. Fragile bones and increased risk of fracture are signs of osteoporosis. When one or more risk factors occur, such as low BMD, family history, previous fracture, thinness, or smoking, a clinical evaluation for osteoporosis is recommended. Identifying depression as a risk factor would improve patient diagnosis and treatment.

Cizza and his colleagues strongly recommend that a clinical evaluation of patients with unexplained bone loss, especially premenopausal women and young or middle-aged men, should include an assessment of depression. Conversely, non-traumatic fractures in a depressed patient should alert the physician to the possibility of osteoporosis.

SOURCES:
Trends in Endocrinology and Metabolism, July 2001
National Institute of Mental Health (http://www.nimh.nih.gov)

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