- hormone levels

[Guest guest]

,

I took a quick look back through my files and what I found were two

things. One is that the hormone levels are better tested with saliva

than blood. But the other concept is that DHEA may work just fine to

increase your testosterone levels and boost your mood. Here are a

couple of articles.

In this 8-week trial, 145 patients with subsyndromal depression or

dysthymia were randomized to receive either DHEA, using flexible

dosing of 100 to 400 mg/day, or placebo. Study completion rates were

90% (69/77) of the DHEA-treated patients and 94% (64/68) of the

placebo-treated patients.

The primary efficacy endpoint, based on intent-to-treat analysis and

completer analysis, was a Clinical Global Impression improvement

rating of 1 or 2 (much or very much improved) plus a final Hamilton

Depression Rating Scale (HAM-D) score of 8 or less. Safety outcomes

included adverse effect reports and measures of CD4 cell count and

HIV RNA viral load at baseline and at week 8.

In the intent-to-treat analysis, clinicians' ratings demonstrated

that DHEA was superior, with response rates of 56% (43/77) for the

DHEA group vs 31% (21/68) for the placebo group. In the completer

analysis, response rates were 62% (43/69) for DHEA and 33% (21/ 64)

for placebo.

Based on intent-to-treat data, the number needed-to-treat was 4 vs

3.4 on the basis of completer data. There were few adverse events

and no significant changes in CD4 cell count or HIV RNA viral load in

either treatment group.

" Nonmajor but persistent depression is common in patients with

HIV/AIDS, and DHEA appears to be a useful treatment that is superior

to placebo in reducing depressive symptoms, " the authors write. " The

low attrition rate in this group of physically ill patients,

together with requests for extended open-label treatment, reflect

high acceptance of this readily available intervention. "

Study limitations include lack of generalizability to patients with

major depression or those with substance use disorders, small number

of women, absence of long-term follow-up regarding maintenance of

response or possible long-term endocrine or other effects of DHEA,

and restriction of the study to HIV-positive individuals.

" Given the high acceptance rate and low side effect profile for DHEA

in this group of patients with HIV/AIDS, nearly all of whom were

taking multiple concurrent medications, it may be appropriate to

evaluate the efficacy of DHEA in other groups of physically ill

patients in which mild depression is common, " the authors conclude.

" We do not recommend widespread use of DHEA in the absence of

confirmatory efficacy research and more data about longer-term use.

For patients who are unwilling to take antidepressants, who express

a strong preference for an 'alternative' treatment, and who have

nonmajor depression, DHEA may be a reasonable choice. "

The National Institutes of Mental Health supported this study.

Am J Psychiatry. 2006;163:59-66

Learning Objectives for This Educational Activity Upon completion of

this activity, participants will be able to:

* Describe the efficacy of DHEA treatment on mood.

* Compare DHEA vs placebo in the treatment of mild depression among

patients with HIV infection.

Clinical Context

DHEA is a weakly active adrenal androgen that serves as a precursor

to testosterone and estradiol, which are hormones that can have a

positive effect on mood when administered exogenously. In addition,

the authors of the current study describe that DHEA increases the

amount of available insulin-like growth factor, which in turn can

increase levels of growth hormone. Growth hormone deficiency has

also been linked with depressed mood. Finally, DHEA may modulate

inflammatory cytokines, such as tumor necrosis factor, which may be

related to depressed mood.

Declines in DHEA levels may also be important in the progression to

AIDS among patients infected with HIV. In their current study,

researchers compare DHEA with placebo in the treatment of mild

depression among a cohort of patients with HIV.

Study Highlights

* Study subjects were adults with HIV who met criteria for dysthymia

or subsyndromal depression of at least 3 months' duration. Patients

were excluded from study participation if they had current unstable

medical conditions, substance abuse, or recent use of steroids.

* Participants were randomized to receive DHEA, which was titrated

to a maintenance dose of 300 to 400 mg/day depending on patient

response, or matching placebo.

* The duration of the trial was 8 weeks. Study outcomes included a

score of very much or much improved on the Clinical Global

Impression scale. The authors also measured scores from the HAM-D . A

measure of participants' quality of life and the Beck Depression

Inventory were also assessed.

Serum DHEA levels were followed to judge their relationship to study

treatment.

* 145 patients underwent randomization, and 92% of participants

finished the 8-week trial. Baseline characteristics between the DHEA

and placebo groups were similar. The mean age of the study cohort

was 44 years old, and 84% of subjects were male. Ethnicity of the

study was cohort was nearly evenly divided between black, white, and

Hispanic subjects. The average duration since the diagnosis of HIV

was 8.6 years, and two thirds of the group had a diagnosis of AIDS.

80% of the study cohort was receiving antiretroviral treatment, and

20% was receiving testosterone supplementation during the trial. 70%

of the study group reported previously receiving treatment of

depression, and 10% had DHEA levels below normal at baseline. The

mean HAM-D score was 16.

improved or very much improved were 56% vs 31% in the DHEA and

placebo groups, respectively, a significant difference. The mean

endpoint HAM-D scores were 8.1 and 9.4, respectively. This difference

was not statistically significant. However, a reduction of at least

50% of the baseline HAM-D score was achieved in 57% of the DHEA group

vs 35% of the placebo group (P = .009).

* Measures of quality of life and the Beck Depression Inventory did

not significantly differ between treatment groups.

* Mean doses of DHEA did not differ between responders and

nonresponders nor did final serum levels of DHEA. Similarly, the

increase in serum DHEA during the study was not associated with

improved study outcomes, and there were no sex differences for DHEA

vs placebo therapy.

* Concomitant steroid therapy did not significantly affect the main

study outcome.

* Serum testosterone levels increased with DHEA therapy in women,

but not in men. DHEA did not significantly affect CD4 counts or the

HIV viral load.

* Rates of adverse events were similar between the placebo and DHEA

groups.

* An open-label continuation phase of DHEA therapy revealed that

DHEA maintained its efficacy in treating depression for 8 months.

Pearls for Practice

* DHEA may improve mood by increasing levels of sex steroids,

insulin-like growth factor, and growth hormone while reducing

activity of inflammatory cytokines.

* In the current study, DHEA improved clinicians' assessment of mild

depression vs placebo among a mostly male cohort of patients with

HIV.

However, DHEA was not more effective than placebo in the outcomes of

HAM-D scores, the Beck Depression Inventory, or quality of life.