Researchers have found that depression is relatively common in HIV positive people. Such depression may also be associated with loss of sex drive and energy. In the 1990s, a number of double-blind studies found that DHEA between 30 mg to 90 mg per day for six to 12 weeks resulted in improved mood and increased energy and sex drive in subjects with and without major depression. To find out the effect of supplements of DHEA on depressed people with HIV, researchers in New York conducted a 16-week study of this hormone. According to their results, some PHAs experienced improved mood.
All subjects were HIV positive and experiencing varying degrees of depression and loss of energy. Although 45 subjects (six female, 39 male) enrolled in the study, only 32 subjects completed the first eight weeks. The profile of subjects at the start of the study was as follows:
Subjects took 100 mg of DHEA per day for the first week of the study then increased the dose to 200 mg/day in the second week and 300 mg/day in the fourth week. Subjects could increase the dose of DHEA beyond 300 mg/day if they did not experience any relief from depression and if there were no significant side effects.
The first part of the study lasted eight weeks and during this time all subjects received DHEA. After this, if a subject's mood had not improved, he/she was removed from the study. Those subjects who responded to DHEA continued taking it for a further four weeks (12 weeks altogether). Subjects whose mood improvement continued through the 12th week were randomly assigned to receive either continued DHEA or fake DHEA (placebo) for a further four weeks. Thus some subjects stayed in the study for up to 16 weeks.
Thirteen subjects (29%) left the study before the 8th week, leaving 32 subjects still participating. Most of these dropouts occurred during the first two weeks of the study for the following reasons:
Of the 32 subjects who completed eight weeks of the study, 72% (23 subjects) reported a "much or very much" improved mood. This improvement was statistically significant. Even when the seven subjects who were taking antidepressants or testosterone (which can also improve mood) were removed from the mood analysis, the response rate of the group was 68%. Improved mood was not linked to DHEA levels at the start of the study. The most common dose of DHEA used was 300 mg/day.
Subjects who remained in the study also reported the following improvements:
The researchers had data about body composition taken at different times from 25 subjects. The doctors found that there was a statistically significant increase in muscle mass by the 12th week of the study. During the placebo-controlled phase of the study — weeks 12 through 16 — there was no further increase in muscle mass for those subjects who continued to receive DHEA. As well, muscle mass did not decrease in those subjects who switched from DHEA to placebo.
From the 12th through 16th week of the study, researchers randomly assigned 21 subjects to receive either continued DHEA or placebo. After analysing blood samples, technicians did not find any significant changes between subjects on placebo and those on DHEA during the final part of the study.
The following side effects were reported by some subjects:
Although some subjects on DHEA experienced increased muscle mass, technicians did not detect any increase in testosterone levels. This is interesting because DHEA is used as a building block for testosterone and estrogen. Other research teams think that DHEA may enhance the body-building effect of testosterone.
Although researchers expected depression to recur when subjects switched from DHEA to placebo it did not. This could possibly be explained by the "placebo effect." The study authors note that improvements in depression seen with placebos in other studies is usually between "20% to 30%." Since at least 75% of subjects had an improvement in the current study, this is not likely due to a placebo effect. As well, increased levels of muscle mass were sustained in those subjects switched from DHEA to placebo for four weeks.
A possible explanation for these findings is that no subject in the study had major depression and that milder forms of depression can be relieved by taking DHEA for three months. Once recovered from depression, subjects may not need continuous doses of DHEA. As well, other placebo-controlled studies have found DHEA useful in treating depression.
The New York doctors are encouraged by the results of this pilot study and are currently conducting another study; they hope to enroll 100 HIV positive subjects to confirm the effect of DHEA on mood. As well, they plan to study the impact of DHEA supplementation on the body's production of other hormones (written communication J Rabkin, 2001).
REFERENCES:
1. Rabkin JG, Ferrando SJ, Wagner GJ and Rabkin R. DHEA treatment for HIV+ patients: effects on mood, androgenic and anabolic parameters. Psychoneuroendocrinology. 2000 (1):53-68.
2. Rabkin JG, Wagner GJ, Rabkin R. A double-blind, placebo-controlled trial of testosterone therapy for HIV-positive men with hypogonadal symptoms. Archive of General Psychiatry 2000;57(2):141-7.
3. Schifitto G, McDermott MP, Evans T, et al. Autonomic performance and dehydroepiandrosterone sulfate levels in HIV-1-infected individuals. Archives of Neurology 2000;57:1027-1032.
4. Morley JE, Kaiser F, Raum W, et al. Potentially predictive and manipulable blood serum correlates of aging in the healthy human male: progressive decreases in bioavailable testosterone, dehydroepiandrosterone sulfate, and the ratio of insulin-like growth factor 1 to growth hormone. Proceedings of the National Academy of Sciences USA 1997;94:7537-7542.
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Copyright © 2001 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284 http://www.catie.ca.
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