The body makes its own dihydroepiandosterone (DHEA) in the adrenal glands; we get very little in our diets. DHEA production peaks from the age of puberty to young adulthood and then begins to decline after age 30. By age 60, our bodies produce just 5 to 15% as much as when we were 20. DHEA is the primary androgen for post-menopausal women. Exercise in the elderly women tends to increase DHEA. DHEA for sale in stores is made from soybeans. DHEA is helpful for the autoimmune disease lupus, at least in women. DHEA might also help prevent osteoporosis. A typical therapeutic dosage of DHEA is 50 mg per day in mood studies and 200 mg daily in lupus studies. A cream containing 10% DHEA may also be used; it is typically applied to the skin at a dosage of 3 to 5 g daily. Physicians sometimes check DHEA levels and adjust the daily dose to achieve blood levels of 20 to 30 nmol/L.

DHEA is available over-the-counter. It has been found to be of some help for depression although the research is still limited. DHEA looks beneficial primarily in women, especially older women. DHEA was found to have beneficial mood, skin, sexual, and bone mineralization effects found in one large study of women over 60 years of age. While some reports of benefit in men exist, most studies in men finding no benefits at all. Normal testosterone in men appears to already be supplying the benefits that women receive from DHEA. The lowest price I found for DHEA was from Vitanet (800-807-8080) at $21.95 for 360 25mg tablets to be taken two a day or $3.50 per month.

While my experience with DHEA has been quite limited, I have had some success. I would consider a cautious trial in depressed women over the age of 45, women with premature ovarian failure, women who might benefit from replacement therapy, and women with lack of sexual arousal.  It may even be of value, at least theoretically, in women becoming depressed on birth control pills, although there is no research on this issue.  Androgenic side effects (greasy skin, acne, increased growth of body, but not facial, hair) occur in over 10% but are mild and reversible by decreasing the dosage. There are also real concerns of increased cancer risks.  

Unfortunately, for both DHEA and estradiol, there is a real concern that these supplements could increase breast cancer in women, especially obese post-menopausal women. Women who naturally have higher levels of both of these hormones have higher rates of breast cancer. One treatment for advanced breast cancer tries to block the effects of naturally occurring DHEA. While there is some evidence of DHEA decreasing breast cancer, the clear majority of the evidence is in the other direction. For men, the concern is on prostate cancer. 

DHEA Helped Middle-Age Depression: In a DB PC crossover study of 46 adults ages 45-65, six weeks of DHEA therapy, 90 mg/d for 3 weeks and 450 mg/d for 3 weeks led to a significant improvement in the 17-Item Hamilton Depression Rating Scale compared to both baseline and placebo (P<.01). A 50% or greater reduction in baseline Hamilton Depression Rating Scale scores was observed in 23 subjects after DHEA and in 13 subjects after placebo treatments. Sexual functioning also improved. Dehydroepiandrosterone monotherapy in midlife-onset major and minor depression. Schmidt PJ, Daly RC, et al. National Institute of Mental Health, Rockville, MD. Arch Gen Psychiatry. 2005 Feb;62(2):154-62

Studies Find DHEA Helps Depression, Midlife-Dysthymia: USA study in which DHEA was administered for three months. Well-being was assessed in both sets of studies and a significant improvement was reported in the longer duration USA study, while no effect was reported in the shorter duration studies. The USA study used an open-ended questionnaire for self-assessment of well-being and stated that 67% of men and 82% of women reported enhanced well-being on DHEA compared with placebo. There was no significant change on an analogue measure of libido. Four brief German studies of 2 wk or less found no benefit. Cochrane Database Syst Rev 2000;(2):CD000304; NIH DB 12 week crossover of 15 depressed women with 3 wk on 90mg/d, 3 wk 450mg/d and 6 wk placebo found 60% response with DHEA vs 20% with placebo (50% decr in depression). Bloch, Biol Psychiatry 1999 Jun 15;45(12):1533-41.

DHEA DB Study Finds Benefit:NIH DB 12 week crossover of 17 depressed men and women with 3 wk on 90mg/d, 3 wk 450mg/d and 6 wk placebo found 60% response with DHEA vs 20% with placebo (50% decr in depression). Dehydroepiandrosterone treatment of midlife dysthymia. Symptoms that improved most significantly were anhedonia, loss of energy, lack of motivation, emotional "numbness," sadness, inability to cope, and worry. Dehydroepiandrosterone showed no specific effects on cognitive function or sleep disturbance. Bloch M, Schmidt PJ, Danaceau MA, Adams LF, Rubinow DR., Biol Psychiatry 1999 Jun 15;45(12):1533-41. Most improving in first three weeks suggested higher dose unnecessary. Psych Drug Alert 8/99

Helps Mood in HIV+ in DB: Of 32 week 8 completers, mood was much improved in 72%, and 81% were rated responders with respect to fatigue. Response on either parameter was unrelated to baseline serum DHEA level. Twenty-one patients entered the double blind discontinuation phase. No differences in relapse rate between placebo and DHEA groups were observed for either mood or fatigue. Body cell mass increased significantly by week 8, and this improvement was maintained throughout the double blind phase for patients in both treatment conditions. Libido increased significantly as well. DHEA therapy did not have an effect on CD4 cell count or on serum testosterone levels in men. DHEA treatment for HIV+ patients: effects on mood, androgenic and anabolic parameters. Rabkin JG, Ferrando SJ, Wagner GJ, Rabkin R. Psychoneuroendocrinology 2000 Jan;25(1):53-68

DHEA Helps Depression: UCSF study of 22 depressed DB 6 wk 90mg/d found 5/11 on DHEA had 50% decr in depression vs 0/11 on placebo. Am J Psychiatry 1999 Apr;156(4):646-9, Wolkowitz. Another report by same author of 6 pt rx 30-90mg/d in open trial with benefit up to 6 months. Biol Psychiatry 1997 Feb 1;41(3):311-8

AJP Says DHEA May Help Depression: Am J Psychiatry 2002 Jul;159(7):1237-9. Elevated basal cortisol levels are a feature of depressive illness and cause deficits in learning and memory. The adrenal steroid dehydroepiandrosterone (DHEA) has antiglucocorticoid properties that may offer protection against the deleterious effects of cortisol. The ratio of cortisol to DHEA higher in 20 drug-free depressed patients vs 19 matched comparison group. However, DHEA higher in 21 PTSD patients than controls: Psychol Med 2000 Sep;30(5):1227-31; DHEA also found decreased in depression remitters at 12 weeks vs those not remitting and no change in cortisol found. Biol Psychiatry 2001 Nov 15;50(10):767-74; Younger US women with depression had higher DHEA-S, altho older depressed women had lower DHEA. Other studies vary, too. Hyperactivity of the HPA-system in major depression is reflected by an increased secretion of adrenal hormones especially cortisol and dehydroepiandrosterone (DHEA). Biol Psychiatry 2001 Nov 1;50(9):705-11; Markedly elevated basal DHEAS levels (mean 2 SD of control value) are associated with resistance to ECT. Biol Psychiatry 2000 Oct 1;48(7):693-701

French Say Good for Elderly Women: studies confirmed positive effects of DHEA in healthy elderly women on skin, bone density, muscle strength and several neuropsychological symptoms. Positive effects on sexual interest and satisfaction and sense of well-being are more consistent in elderly women than in men. The recommended dose 25 mg to 50 mg once a day in women and 100 mg in men. Androgenic side effects (greasy skin, acne, increased growth of body hair) are frequent but reversible. May be used in adrenal insufficiency. Other possible indications are depression and prolonged glucocorticoid therapy. In elderly people, DHEA administration might be considered in DHEA depleted-patients with skin dryness or atrophy, muscle weakness, low bone density or neuropsychological symptoms. The treatment should be taken under close medical supervision in order to detect a possible hormone-dependent cancer such as breast cancer in women and prostatic cancer in men. Rev Med Brux 2001 Sep;22(4):A381-6;

DHEA Helps Adrenal Insufficiency: DHEA 50mg/d significantly improved overall wellbeing of 24 Adrenal Insufficiency women in crossover DB as well as scores for depression, anxiety, and their physical correlates. Furthermore, DHEA significantly increased both sexual interest and the level of satisfaction with sex. Usually only mineralo and glucocorticoids given in AI. U Wurzburg, Germany Endocr Res 2000 Nov;26(4):505-11; There is an increased incidence of depression in 20 facially hirsute women and this correlates with their circulating active testosterone levels and not with the extent of their facial hirsutism. DHEA apparently not associated with depression. : J Am Acad Dermatol 1992 Aug;27(2 Pt 1):178-81

DHEA Not Helpful in Peri-menopausal DB: 60 peri-menopausal women with c/o mood and well-being 50mg/d 3 mo. DB PC. Women receiving DHEA did not have any improvements significantly greater than placebo in the severity of perimenopausal symptoms, mood, dysphoria, libido, cognition, memory, or well-being. The effect of dehydroepiandrosterone supplementation to symptomatic perimenopausal women on serum endocrine profiles, lipid parameters, and health-related quality of life. Barnhart KT, Freeman E, et al. J Clin Endocrinol Metab 1999 Nov;84(11):3896-902

DHEA Helps Libido, Skin, Bones Elderly Women: DB PC 280 men and women 60-79yos 50mg/d for 1 yr. No harmful effects. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge Study to a sociobiomedical issue. Baulieu EE, Thomas G, et al. Proc Natl Acad Sci U S A 2000 Apr 11;97(8):4279-84

DHEA Good for Cognition: Counteracts deleterious effects of corticosteroids on long-term potentiation and improves learning and memory. DHEA improved cognition in middle age and elderly depressed. Cortisol/DHEA ratio increases in depressed in drug-free salivary testing. AJP 7/02; 159:1237

DHEA Case of Manic Agitation: 31yo hispanic male with history of violence when intoxicated became violent after 3 weeks of DHEA. Ann Pharmacother 2000 Dec;34(12):1419-22.

DHEA-S Much Lower in Alzheimers: Biol Psychiatry 2000 Jan 15;47(2):161-3

DHEA Associated with Well Being: 140 women 40-60 studied. The only steroid hormone positively related to well-being was dehydroepiandrosterone (DHEA). Psychol Med 1996 Sep;26(5):925-36

DHEA No Benefit for Fibromyalgia; Causes Acne, Greasy Skin, Body Hair: In a 3-month DB PC crossover study (one month washout) of 52 adults with fibromyalgia, DHEA supplementation (50 mg/day) caused no improvement in well-being, pain, fatigue, cognitive dysfunction, functional impairment, depression, or anxiety, nor in objective measurements made by physicians. Androgenic side effects (greasy skin, acne, and increased growth of body hair) were more common during the DHEA treatment period (p = 0.02). A randomized controlled trial of dehydroepiandrosterone in postmenopausal women with fibromyalgia. Finckh A, et al. Lausanne, Switzerland. J Rheumatol. 2005 Jul;32(7):1336-40

Thomas E. Radecki, M.D., J.D.

 modern-psychiatry.com