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Clinical question
Is dehydroepiandrosterone useful in the treatment of midlife-onset
depression?
Bottom line
Dehydroepiandrosterone (DHEA) is moderately effective in the treatment of
midlife-onset depression.Since other treatments have been studied for longer
periods, it makes sense to use these approaches first until we get more long
term study with DHEA. (LOE = 1b)
Reference
Schmidt PJ, Daly RC, Bloch M, et al. Dehydroepiandrosterone monotherapy in
midlife-onset major and minor depression. Arch Gen Psychiatry 2005;
62:154-62.
Study design: Cross-over trial (randomized)
Setting: Outpatient (specialty)
Synopsis
DHEA is available as an over-the-counter hormonal therapy reported to have
antidepressant effects. The investigators identified 52 adults, aged 45 to
65 years, with major or minor depression of less than 5 years duration, who
were not taking concurrent antidepressant medications. Subjects were
randomized (using concealed allocation assignment) in a double-blind,
crossover fashion to receive either DHEA or matched placebo. Each treatment
phase lasted 6 weeks with a 1- to 2-week washout before crossover. The dose
of DHEA was 30 mg 3 times a day for 3 weeks, followed by 150 mg 3 times a
day for 3 weeks. Women received a 10-day course of medroxyprogesterone
acetate at the end of the trial to cause shedding of possible endometrial
growth stimulated by DHEA. Individuals assessing outcomes were blinded to
treatment group assignment and order. A total of 46 patients (88%) were
followed up for the entire 6 weeks. A 50% or greater reduction in baseline
Hamilton Depression Rating Scale scores was reported by 23 subjects (50%)
after DHEA treatment versus 13 (28%) subjects after placebo treatment
(number needed to treat = 5; 95% CI, 3 - 55). Rare serious adverse events,
if any, would not be detected by this small trial . |