Testosterone For Depression?
01-10-2003 07:05 PM
Testosterone For Depression?
Here's something I found on WebMd And Im curious to know those of you who have used Test of any type, how was your mood when on? And a couple weeks after?
Jan. 6) -- Testosterone replacement therapy was commonly prescribed 50 years ago for depression in men, but the treatment was all but abandoned with the introduction of antidepressant drugs. Now new research suggests the male hormone may have been rejected too quickly.
A small study from Harvard Medical School's McLean Hospital showed that nearly half of the men who had not responded to conventional depression treatment had low or low-to-normal testosterone levels. And several showed dramatic improvement when the male hormone was given along with antidepressants.
Although the findings are preliminary, they suggest that lower-than-normal testosterone levels may be common in depressed men who fail to get better when taking antidepressants, says lead researcher Harrison G. Pope, Jr., MD.
"We were astonished to find that nearly half of the men in our study had low or borderline testosterone levels," he tells WebMD. "It may turn out that there is a weak relationship between testosterone and depression in general, but a much stronger relationship between testosterone and depression that does not respond to treatment."
Until a decade ago, testosterone had to be given by injection. But its use widened with the introduction of testosterone patches, and, more recently, a gel that allows testosterone to be absorbed through the skin.
The study, reported this month in the American Journal of Psychiatry, included 22 depressed men with low to low-to-normal testosterone levels who did not respond to antidepressants. Half of the men received the testosterone gel for eight weeks, the other half received a placebo gel, and all continued taking antidepressant medications.
Pope tells WebMD that about a third of the men who received the testosterone treatment showed dramatic improvement in mood, anxiety, and other measures of depression. The remaining men showed either some improvement or none.
"The $64,000 question is why some of these men responded so dramatically and others did not respond at all," Pope says. "I have also seen this in my research on anabolic steroid abuse. Most steroid users -- even those who take extremely high doses -- do not exhibit striking mood changes, but others do."
While the findings need to be confirmed in larger studies, Pope says depressed men who are not responding to treatment may want to have their testosterone level checked. Testosterone replacement might be considered for those with low levels of the male hormone, but the researcher cautions that the health risks of long-term supplementation -- which include prostate cancer -- are not well understood.
He speculates that much lower dosages of testosterone than those given to men may also prove beneficial in certain groups of depressed women.
Depression expert Douglas G. Jacobs, MD, tells WebMD that the new findings may have important implications for treating patients who do not respond to conventional therapies.
"Our understanding of depression is certainly greater than it was 30 years ago, but the biology of depression is extremely complex," says Jacobs, founder and executive director of National Depression Screening Day. "Certainly the relationship between hormone and mood has a long history in psychiatry and anything that further contributes to our understanding of this relationship is positive. "
SOURCES: American Journal of Psychiatry, January 2003 • Harrison G. Pope, Jr., MD, chief of biological psychiatry laboratory, McLean Hospital-Harvard Medical School, professor of psychiatry, Harvard Medical School, Boston • Douglas G. Jacobs, MD, associate clinical professor of psychiatry, Harvard Medical School, founder and executive director, National Depression Screening Day.
© 2003 WebMD Inc. All rights reserved.
01-10-2003 07:27 PM
Suddenly I became depressed ...whos gotz da test?
01-10-2003 08:30 PM
I'll cry you a river right here on the spot. Now where is my script uhh I mean my theraputic medicine.
01-13-2003 12:22 PM
I noticed while on 1-test I was happier and just felt better. While coming off I was an emotional bitch, I had mood swings all the time.
01-13-2003 05:08 PM
Been on the happy pills for a while (prozac) and while they're ok-ish, I certainly feel better if taking anything androgenic (dBol etc)
01-13-2003 05:29 PM
Running with the Big Boys
umm.. now I go to the doctor on Thursday.. might see what I can get out to that visit..
01-23-2003 11:02 AM
Testosterone Gel Helpful in Refractory Depression
Laurie Barclay, MD
Jan. 15, 2003 — Men who have depression refractory to usual antidepressants may benefit from testosterone gel, according to the results of a randomized, placebo-controlled trial reported in the January issue of the American Journal of Psychiatry.
"Testosterone supplementation may produce antidepressant effects in men, but until recently it has required cumbersome parenteral administration," write Harrison G. Pope, Jr., MD, and colleagues from McLean Hospital in Belmont, Massachusetts.
The authors administered testosterone transdermal gel to men aged 30 to 65 years with refractory depression and low or borderline testosterone levels. Of 56 men screened, 24 (42.9%) had morning serum total testosterone levels of 350 ng/dL or lower (normal range, 270-1070 ng/dL).
Of 23 men enrolled in the study, one responded to an initial one-week, single-blind placebo period, and 22 were subsequently randomized to 1% testosterone gel, 10 g/day, or to identical-appearing placebo. All subjects continued their baseline antidepressant regimen. Ten of 12 subjects receiving testosterone and nine of 10 receiving placebo completed the eight-week trial. At baseline, both groups had similar demographic and psychiatric measures.
Compared with the placebo group, the testosterone gel group had significantly greater improvement in scores on the Hamilton Depression Rating Scale and on its vegetative and affective subscales, and on the Clinical Global Impression severity scale, but not on the Beck Depression Inventory. Testosterone gel appeared to improve psychological aspects of depression, as reflected in the depressed mood, guilt, and psychological anxiety items of the Hamilton Depression Rating Scale, to nearly the same extent as the somatic aspects of depression.
The only treatment-related adverse event was increased difficulty with urination in one subject, suggesting exacerbation of benign prostatic hyperplasia.
"These preliminary findings suggest that testosterone gel may produce antidepressant effects in the large and probably underrecognized population of depressed men with low testosterone levels," the authors write.
Although mean age in this study was 46.9 years, mean total testosterone level was only 403 ng/dL (SD = 152 ng/dL), dramatically lower than expected in the general population of men aged 45 to 54 years, and slightly lower than in an earlier study of depressed men in their 60s and 70s.
"These observations suggest that low testosterone levels may be unexpectedly common in middle-aged men with treatment-resistant major depressive disorder, perhaps because chronic depressive symptoms lead to blunting of the hypothalamic-pituitary-gonadal axis or, possibly, because of effects of the antidepressant medications themselves," the authors write.
Study limitations include limited statistical power, short duration, breaking the blind for each subject individually at termination rather than for all subjects at the conclusion of the study, use of a single serum total testosterone level to determine eligibility, addition of testosterone to existing antidepressant treatment, and inclusion of men only.
Potential risks of testosterone supplementation include development of paranoid symptoms, especially in subjects taking tricyclic antidepressants, and possible longer-term effects such as gynecomastia, adverse effects on lipid fractions, gradual exacerbation of benign prostatic hyperplasia, suppression of the hypothalamic-pituitary-testicular axis, and possible increased risk of prostate or other cancers.
"These findings may have important consequences for public health. In a given year, about 8% of American men over the age of 30 years exhibit major depressive disorder, and many of these cases will be partially or completely refractory to an adequate trial of antidepressant medication," the authors write. "If this subgroup with refractory depression has a 43% prevalence of low testosterone levels, as found in the present study, then hundreds of thousands of men in a given year might at least theoretically be candidates for testosterone supplementation to treat depression. Given the size of this population, together with the increased availability and convenience of transdermal testosterone preparations, it seems important to assess carefully both the benefits and the risks of this antidepressant treatment strategy."
Am J Psychiatry. 2003;160:105-111
Reviewed by Gary D. Vogin, MD
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