Clinical Question: Is dehydroepiandrosterone (DHEA) useful in the treatment of midlife-onset depression?

Setting: Outpatient (specialty)

Study Design: Crossover trial (randomized)

Allocation: Concealed

Synopsis: In this study, investigators identified 52 adults, 45 to 65 years of age, with major or minor depression of less than five years’ duration who were not receiving concurrent antidepressant medications. Patients were randomized in a double-blind, crossover fashion to receive DHEA or matched placebo. Each treatment phase lasted six weeks with a one- to two-week washout period before crossover. The dosage of DHEA was 30 mg three times a day for three weeks, followed by 150 mg three times a day for three weeks. Women received a 10-day course of medroxyprogesterone acetate at the end of the trial to shed possible endometrial growth stimulated by DHEA. Persons assessing outcomes were blinded to treatment group assignment and order.

A total of 46 patients (88 percent) were followed for the entire six weeks. A 50 percent or greater reduction in baseline scores on the Hamilton Depression Rating Scale was reported by 23 patients (50 percent) after DHEA treatment compared with 13 patients (28 percent) after placebo treatment (number needed to treat = five; 95 percent confidence interval, three to 55). Rare, serious adverse events, if any, would not be detected by this small trial.

Bottom Line: DHEA is moderately effective in the treatment of midlife-onset depression. Because other treatments have been studied for longer periods, it makes sense to use these approaches first until we have more long-term studies of DHEA. (Level of Evidence: 1b)