Suzanne Leigh, Medical Tribune News Service
The steroid hormone DHEA has been associated with benefits as
varied as boosting the immune system, reversing the aging process,
preventing heart disease and cancer, and building muscle. But it is
DHEA's effects on alleviating depression that may provide the most
cause for optimism.
It is known that production of DHEA, or dehydroepiandrosterone,
starts to decline as people reach their late 20s and slumps to
about 5 to 10 percent of its peak level by age 80. Some scientists
believe this phenomenon partially explains the greater incidence of
depression and suicide among seniors.
In addition, a number of studies have pointed to the prevalence
of low DHEA in people suffering from post-partum depression,
anorexia nervosa and schizophrenia.
The use of DHEA supplements to self-treat a condition that has
been coined ``chronic DHEA deficiency'' by the health food stores
that sell it should not be considered until more is known about its
safety and effectiveness, according to a leading psychiatrist who
is involved in ongoing DHEA research.
``We do not know if there are only certain subgroups of patients
that respond to [DHEA]. There are also cases of patients becoming
overly activated, aggressive or psychotic with the treatment,''
said Dr. Owen Wolkowitz in an interview. Wolkowitz is professor of
psychiatry and director of the Psychopharmacology Assessment Clinic
at the University of California at San Francisco (UCSF). Such
cases, though, are probably rare, he noted, and similar adverse
reactions have also been associated with prescription
antidepressants.
A study conducted by Wolkowitz and co-principal investigator Dr.
Victor Reus, also of UCSF, suggests that DHEA may eventually be
useful as a therapy for depression.
In a study, 22 patients suffering from severe depression, as
defined by their ranking on the Hamilton Depression Rating Scale
(HDRS), were given either DHEA or placebo. After six weeks,
patients were re-evaluated for depression. While none of the 11
placebo recipients experienced a significant improvement, five of
the 11 DHEA recipients showed a decrease of 50 percent or more in
depressive symptoms, according to a report of the study published
earlier this year in the American Journal of Psychiatry.
Results of an ongoing study of DHEA and depression conducted by
Wolkowitz and his UCSF colleague Dr. Louann Brizendine are expected
to be revealed next year.
DHEA was investigated as early as the 1950s, when studies
indicated the treatment may be beneficial for patients suffering
from ``inadequate personality'' and ``emotional and constitutional
immaturity.'' Interest in DHEA gained momentum in the 1990s, but
most studies have been on animals, were not placebo-controlled, or
involved only a small number of people.
The mechanism by which DHEA elevates mood remains unclear but it
is generally believed that it acts as a ``buffer'' against the
damaging effects of cortisol, a hormone associated with stress.
Interestingly, while levels of DHEA decline with age, cortisol
levels rise or remain constant as people age.
DHEA is also believed to increase the brain chemical serotonin,
deficiencies of which have been implicated in depression. Finally,
DHEA is partially metabolized to estrogen and testosterone,
hormones that have also been linked to mood. While administered
doses of estrogen and testosterone may be beneficial for many
people, they represent a red flag to patients at risk of
hormone-sensitive tumors such as cancers of the breast, cervix,
uterus and prostate.
``It is very prudent for [people in this risk group] to avoid
DHEA,'' said Wolkowitz. ``People taking DHEA for several months or
longer should be medically followed for such tumors.''
