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CME

DHEA May Be Effective for Depression Associated With HIV

  • Authors: News Author: Laurie Barclay, MD
    CME Author: Charles Vega, MD, FAAFP
  • CME Released: 1/24/2006
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 1/24/2007
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Target Audience and Goal Statement

This article is intended for primary care clinicians, psychiatrists, infectious disease specialists, and other specialists who care for patients with mild depression, dysthymia, or HIV infection.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  • Describe the efficacy of DHEA treatment on mood.
  • Compare DHEA vs placebo in the treatment of mild depression among patients with HIV infection.


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Author(s)

  • Laurie Barclay, MD

    Laurie Barclay is a freelance reviewer and writer for Medscape.

    Disclosures

    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Reviewer(s)

  • Gary Vogin, MD

    Senior Medical Editor, Medscape

    Disclosures

    Disclosure: Gary Vogin, MD, has disclosed no relevant financial relationships.

CME Author(s)

  • Charles P Vega, MD

    Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine

    Disclosures

    Disclosure: Charles Vega, MD, FAAFP, has disclosed that he has received grants for educational activities from Pfizer.


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CME

DHEA May Be Effective for Depression Associated With HIV

Authors: News Author: Laurie Barclay, MD CME Author: Charles Vega, MD, FAAFPFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME Released: 1/24/2006

Valid for credit through: 1/24/2007

processing....

Jan. 24, 2006 -- Dehydroepiandrosterone (DHEA) is an effective therapy for treatment of nonmajor depression in patients with HIV/AIDS, according to the results of a randomized trial reported in the January issue of the American Journal of Psychiatry.

"Subsyndromal major depressive disorder is common among HIV-positive adults," write Judith G. Rabkin, PhD, MPH, from the New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons in New York, and colleagues. "DHEA is of particular interest for HIV-positive patients, because declining levels of DHEA have been associated with progression to AIDS in both cross-sectional comparisons of HIV-positive men and women at different stages of HIV illness and in longitudinal studies, including a previous study by our group."

In this 8-week trial, 145 patients with subsyndromal depression or dysthymia were randomized to receive either DHEA, using flexible dosing of 100 to 400 mg/day, or placebo. Study completion rates were 90% (69/77) of the DHEA-treated patients and 94% (64/68) of the placebo-treated patients. The primary efficacy endpoint, based on intent-to-treat analysis and completer analysis, was a Clinical Global Impression improvement rating of 1 or 2 (much or very much improved) plus a final Hamilton Depression Rating Scale (HAM-D) score of 8 or less. Safety outcomes included adverse effect reports and measures of CD4 cell count and HIV RNA viral load at baseline and at week 8.

In the intent-to-treat analysis, clinicians' ratings demonstrated that DHEA was superior, with response rates of 56% (43/77) for the DHEA group vs 31% (21/68) for the placebo group. In the completer analysis, response rates were 62% (43/69) for DHEA and 33% (21/ 64) for placebo. Based on intent-to-treat data, the number needed-to-treat was 4 vs 3.4 on the basis of completer data. There were few adverse events and no significant changes in CD4 cell count or HIV RNA viral load in either treatment group.

"Nonmajor but persistent depression is common in patients with HIV/AIDS, and DHEA appears to be a useful treatment that is superior to placebo in reducing depressive symptoms," the authors write. "The low attrition rate in this group of physically ill patients, together with requests for extended open-label treatment, reflect high acceptance of this readily available intervention."

Study limitations include lack of generalizability to patients with major depression or those with substance use disorders, small number of women, absence of long-term follow-up regarding maintenance of response or possible long-term endocrine or other effects of DHEA, and restriction of the study to HIV-positive individuals.

"Given the high acceptance rate and low side effect profile for DHEA in this group of patients with HIV/AIDS, nearly all of whom were taking multiple concurrent medications, it may be appropriate to evaluate the efficacy of DHEA in other groups of physically ill patients in which mild depression is common," the authors conclude. "We do not recommend widespread use of DHEA in the absence of confirmatory efficacy research and more data about longer-term use. For patients who are unwilling to take antidepressants, who express a strong preference for an 'alternative' treatment, and who have nonmajor depression, DHEA may be a reasonable choice."

The National Institutes of Mental Health supported this study.

Am J Psychiatry. 2006;163:59-66