DHEA – for Depression in Elderly – Seemed Like a Good Idea..

Antidepressants are poorly tolerated in elderly and DHEA, found to be low in elderly, has been found to help with depression. I suspect part of its effect is through androgen stimulation as some is converted to such.  I have patients order DHEA from USA and have it sent C/O my office as I thought it would legitimize its import.  Had a visit today from 2 men from Canada Customs who made it clear that wasn’t so.

Some literature on antidepressant effects:

Wolkowitz, O. M., et al.
Antidepressant and Cognition‐Enhancing Effects of DHEA in Major Depression.
Annals of the New York Academy of Sciences 774.1 (1995): 337-339.
https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1111/j.1749-6632.1995.tb17403.x-i1

  • 6 subjects aged 51-72
  • dose 60-90 mg/day
  • results not great but neither was dose (<7 = no depress)

Wolkowitz, Owen M., et al.
Double-blind treatment of major depression with dehydroepiandrosterone.
American Journal of Psychiatry 156.4 (1999): 646-649.
https://ajp.psychiatryonline.org/doi/full/10.1176/ajp.156.4.646

  • DHEA 30 mg/day for the first 2 weeks, then 30 mg b.i.d. for 2 weeks, and then 30 mg t.i.d. for the final 2 weeks
  • “The mean percentage change in Hamilton depression scale ratings in the DHEA group was 30.5% (SD=29.1), compared with 5.3% (SD=20.2) in the placebo group. Five of 11 DHEA treated subjects were considered treatment responders, compared with none of 11 placebo-treated subjects.  does not give actual values so I cannot graph it

Schmidt, Peter J., et al.
Dehydroepiandrosterone monotherapy in midlife-onset major and minor depression.
Archives of general psychiatry 62.2 (2005): 154-162.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/208294

  • Six weeks of DHEA therapy, 90 mg/d for 3 weeks and 450 mg/d for 3 weeks, and 6 weeks of placebo
  • aged 45-60
  • results are more robust with higher dose

Annoyingly, could not find any other studies except in HIV subjects. – There is no money in researching a generic drug…

The Canadian standards:
Ravindran, Arun V., et al.
Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 5. Complementary and Alternative Medicine Treatments.
Focus 16.1 (2018): 85-94.
https://focus.psychiatryonline.org/doi/pdf/10.1176/appi.focus.16106

Classifies it for use in mild – moderate MMD depression, third line.

Comment – I use it in milder cases in the elderly. Getting it from USA is much cheaper than getting it compounded. I use 100 mg tid and found it helpful without side effects. Now, that option in Canada, has been eliminated. Don’t customs people have elderly parents who could maybe need this? nike air max 1 nike air max 1

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