DHEA may reduce depression symptoms in HIV patients

NEW YORK (Reuters Health) – The dietary supplement DHEA seems to relieve the symptoms of minor depression in patients infected with HIV, the virus that causes AIDS, according to a new report. “Based on our trial and the handful of others in the literature, I don’t think any of us would recommend DHEA as first-line treatment for depression,” Dr. Judith G. Rabkin told Reuters Health. “DHEA is, however, attractive for patients who refuse to take antidepressants or for patients with mild chronic depression who are particularly enthusiastic about complementary-alternative medicine strategies.”

DHEA, which stands for dehydroepiandrosterone, is an unregulated steroid-like supplement to treat a variety of conditions. People take DHEA to build muscles, reduce abdominal fat, improve blood sugar levels and as an antiaging remedy, among other reasons. Rabkin from Columbia University College of Physicians and Surgeons, New York and colleagues assessed the effectiveness of DHEA in an eight-week trial involving 145 HIV-positive adults with mild depression. Two thirds had a diagnosis of AIDS, according to the report in the American Journal of Psychiatry.

Participants were randomly assigned to placebo or DHEA tablets, starting at 100 milligrams per day, and increased up to 400 milligrams per day over 4 weeks if symptoms did not improve and if there were no side effects. The response rate was higher for DHEA patients (56 percent) than for placebo patients (31 percent), the researchers report, and women and men responded equally well to DHEA. Blood levels of DHEA did not differ significantly between responders and nonresponders, the results indicate.

DHEA treatment was associated with a significant increase in testosterone levels in women, but not in men, the researchers note. DHEA did not significantly affect CD4+ cell levels, a standard measure of immune function, or HIV viral load. Side effects during treatment were relatively uncommon and did not differ between treatment groups, the report indicates. “In response to many requests, we added a four-month extension phase for patients who responded to DHEA,” the investigators write. “Overall, the results of this intermediate-term eight-month follow-up suggest that mood response is maintained with minimal and possibly nonspecific side effects, although long-term effects remain unknown.” “It would be extremely useful if there is some federal regulation/oversight of the purity and contents of substances such as DHEA that are sold over-the-counter, Rabkin suggested. The amount of DHEA in several samples bought by the researchers at health food stores ranged from 0 to 150 percent of what was on the label.

Another problem is dosing. “DHEA in 100 milligram tablets is hard to find in health food stores, where tablets usually are 25 milligrams,” Rabkin explained. “Also, because it is not classified as a drug, insurance won’t pay for it, which was a hardship for some of our patients on disability with minimal income, even though it is inexpensive.”

SOURCE: American Journal of Psychiatry, January 2006.

By Will Boggs, MD