Hormones in mood disorders
Dehydroepiandrosterone (DHEA) is an androgen produced by the adrenal glands, levels of which tend to decrease during mid-life in men and women. Lower levels of DHEA have been reported in patients with major depression, and use of DHEA has been associated with improved mood. An increase in DHEA sulfate, the primary metabolite of DHEA, has also been associated with improvement in depression and dysthymia.156–157 In a randomized controlled trial, 23 men and 23 women with major or minor mid-life depression were given DHEA 90 mg/day for three weeks, then 450 mg/day for a further three weeks, or placebo for six weeks. A 50% or greater reduction in baseline Hamilton Depression Rating scores was observed in the 23 subjects who took DHEA and in 13 subjects who took placebo. Patients taking DHEA also showed improvement in sexual function.158 DHEA has been used effectively in patients with human immunodeficiency virus/acquired immune deficiency syndrome and subsyndromal depression or chronic dysthymia. Of 145 such patients given DHEA 100–400 mg/day for 8 weeks, 64% showed a more than 50% reduction in depression scores compared with 38% of those given placebo.159 The response was maintained for 8 months of follow-up, and was higher among those with increased levels of DHEA sulfate.159 Arguably, subsyndromal depression and dysthymia are not the same as major depression. In a recent study, DHEA 100 mg/day or placebo was administered to 26 patients with anorexia nervosa, whose assessment included mood symptoms. Patients receiving DHEA experienced significant improvement in mood and body mass index, although there was no difference in bone marrow density. Thus, comorbid depression in patients with eating disorders may benefit from the use of DHEA.160 DHEA should be used in low doses in bipolar patients because it may induce manic-like symptoms, irritation, and bouts of aggression, and increase testosterone and estrogen levels, resulting in an elevated risk of uterine or breast cancer, vaginal bleeding, endometrial hyperplasia, and venous thrombosis.57