DHEA metabolism to the neurosteroid androsterone: a possible mechanism of DHEA's antidepressant action.

MENTAL depression; THERAPEUTICS; AFFECTIVE disorders; DEHYDROEPIANDROSTERONE; ANTIDEPRESSANTS; DRUG metabolism; DRUG efficacy

Background: Alterations in neurosteroid secretion have been implicated in the efficacy of antidepressants. In a previous study, the adrenal androgen DHEA, a precursor of the neurosteroid androsterone, produced antidepressant and libido-enhancing effects in patients with midlife depression. To investigate the mechanisms underlying DHEA's behavioral effects in this same patient group, we examined plasma levels of four additional neurosteroids implicated in the regulation of affective behavior. Methods: Blood samples were assayed for neurosteroids in men ( n = 13) and women ( n = 10) with midlife depression who previously participated in a crossover study in which DHEA and placebo were administered for 6 weeks each. Depression severity was measured by the Center for Epidemiologic Studies Depression Scale (CES-D). Plasma levels of androsterone (ADT), allopregnanolone, pregnanolone, and pregnenolone were measured by GC-MS at baseline and week 6 of each treatment phase. Data were analyzed with repeated measures analysis of variance (ANOVA-R) and Bonferroni t tests. Results: ADT levels (but not allopregnanolone, pregnanolone, and pregnenolone) increased after DHEA but not after placebo ( F = 3.3, p < 0.05). Post-DHEA ADT levels were higher in women than men [ t = 2.9, p < 0.05]. However, in both men and women who met criteria for clinical response on the CES-D, baseline ADT levels significantly increased post-DHEA, and the magnitude of the ADT increase post-DHEA treatment was similar in men and women. Consequently, it was the non-responders who accounted for the sex difference in post-DHEA plasma ADT levels, a difference that was driven by values in two women (the only female non-responders). Conclusions: The small sample size notwithstanding, these data emphasize the potential behavioral relevance of ADT in humans, which may include contribution to the antidepressant effects of DHEA. [ABSTRACT FROM AUTHOR]

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