Abstract
Our research program was designed to assess androgenic, anabolic, and mood effects of testosterone replacement therapy in human immunodeficiency virus positive (HIV+) men with significant immune suppression and hypogonadism. This article focuses on mood effects. Treatment consisted of biweekly intramuscular injections of testosterone cypionate at doses of 200 to 400 mg. Assessments included psychiatric evaluation using the Structured Clinical Interview for DSM-III-R, Hamilton Rating Scale for Depression, and Brief Symptom Inventory. This is an interim report of 73 men who completed at least eight weeks of treatment. Responders continued for four more weeks and then entered a double-blind placebo controlled discontinuation phase.
At study entry, 49% had CD4 counts under 50, and 84% had an acquired immune deficiency syndrome (AIDS)-defining condition. In terms of sexual desire and function, 76% were clear-cut responders at Week 8. Of the 31 study completers who had mood problems at baseline, 26 (84%) were rated as much improved in mood. Mean changes in CD4 cell count and beta 2 microglobulin after treatment were not statistically significant. These findings suggest that testosterone replacement therapy has significant antidepressant effects for men with significant immunodeficiency and clinical manifestations of hypogonadism.
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Atkinson JH, Grant I: Natural history of neuropsychiatric manifestations of HIV disease.Psychiatric Clinics of North America. 1994,17:17–34.
Williams JBW, Rabkin JG, Remien RH, et al: Multidisciplinary baseline assessment of homosexual men with and without human immunodeficiency virus infection. II. Standardized clinical assessmenr of current and lifetime psychopathology.Archives of General Psychiatry. 1991,48:124–130.
Perkins DO, Stern RA, Golden RN, et al: Mood disorders in HIV infection: Prevalence and risk factors in a nonepicenter of the AIDS epidemic.American Journal of Psychiatry. 1994,151:233–236.
Rosenberger PH, Bornstein RA, Nasrallah HA, et al: Psychopathology in HIV infection: Lifetime and current assessment.Comprehensive Psychiatry. 1993,34:150–158.
Chuang HT, Devins GM, Hunsley J, et al: Psychosocial distress and well-being among gay and bisexual men with HIV infection.American Journal of Psychiatry. 1989,146:876–880.
Chung J, Popkin M, Rhame F, et al: HIV clinic-based study of psychiatric disorders (Abstract NR603).1993 New Research Program and Abstracts, 146th Annual Meeting, American Psychiatric Association. Washington, DC: American Psychiatric Association, 1993, 211.
Perdices M, Dunbar N, Grunseit A, et al: Anxiety, depression, and HIV-related symptomatology across the spectrum of HIV disease.Australian & New Zealand Journal of Psychiatry. 1992,26:560–566.
Rabkin JG, Remien RH, Katoff L, et al: Resilience in adversity among long-term survivors of AIDS.Hospital and Community Psychiatry. 1993,44:162–167.
Robins LN, Regier D:Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York: Free Press, 1991.
Lipsitz JD, Williams JBW, Rabkin JG, et al: Psychopathology in male and female intravenous drug users with and without HIV infection.American Journal of Psychiatry. 1994,151:1662–1668.
Joseph JG, Caumartin SM, Tal M, et al: Psychological functioning in a cohort of gay men at risk for AIDS. A three-year descriptive study.Journal of Nervous and Mental Disorders. 1990,178:607–615.
Perry SW, Jacobsberg L, Card C, et al: Severity of psychiatric symptoms after HIV testing.American Journal of Psychiatry. 1993,150:715–779.
Burack J, Barrett D, Stall R, et al: Depressive symptoms and CD4 lymphocyte decline among HIV-infected men.Journal of the American Medical Association. 1993,270:2568–2573.
Lyketsos C, Hoover D, Guccione M, et al: Depressive symptoms as predictors of medical outcomes in HIV infection. Multicenter AIDS Cohort Study.Journal of the American Medical Association. 1993,270:2563–2567.
Perry SW, Fishman B: Depression and HIV: How does one affect the other?Journal of the American Medical Association. 1993,270: 2609–2610.
Rabkin JG, Rabkin R, Harrison W, Wagner G: Effect of imipramine on mood and enumerative measures of immune status in depressed patients with HIV illness.American Journal of Psychiatry. 1994,151:516–523.
MacArthur J, Harrison M: HIV-associated dementia.Current Neurology. 1994,74:275–320.
Stern Y, Marder K, Bell K, et al: Multidisciplinary baseline assessment of homosexual men with and without human immunodeficiency virus infection. III. Neurologic and neuropsychologic findings.Archives of General Psychiatry. 1991,48:131–138.
Manning D, Jacobsberg L, Erhart S, et al: The efficacy of imipramine in the treatment of HIV-related depression.International Conference on AIDS. 1990,6:141.
Rabkin JG, Wagner G, Rabkin R: Sertraline effects on mood and immune status in patients with major depression and HIV illness: An open trial.Journal of Clinical Psychiatry. 1994,55:433–439.
Rabkin JG, Rabkin R, Wagner G: Fluoxetine effects on mood and immune status in depressed patients with HIV illness.Journal of Clinical Psychiatry. 1994,55:92–97.
Levine S, Anderson D, Bystritsky A, et al: Report of eight HIV-seropositive patients with major depression responding to fluoxetine.Journal of Acquired Immune Deficiency Syndromes. 1990,3:1074–1077.
Markowitz J, Rabkin JR, Perry S: Treating depression in HIV+ patients. (Invited Editorial Review).AIDS. 1994,5:403–412.
Kelly JA, Murphy DA, Bahr GR, et al: Outcome of cognitive-behavioral and support group brief therapies for depressed, HIV-infected persons.American Journal of Psychiatry. 1993,150:1679–1686.
Jacobsen FM: Managing sexual dysfunction and SSRIs.Psychiatric Times. 1995,February edition:38–39.
Rubin RT: Sex steroid hormone dynamics in endogenous depression: A review.International Journal of Mental Health. 1981,10: 43–59.
Vogel W, Klaiber E, Broverman D: A comparison of the antidepressant effects of a synthetic androgen (Mesterolone) and amitriptyline in depressed men.Journal of Clinical Psychiatry. 1985,46:6–8.
Luisi M, Franchi F: Double-blind group comparative study of testosterone undecanoate and mesterolone in hypogonadal male patients.Journal of Endocrinological Investigation. 1980,5:305–308.
O’Carroll R, Shapiro C, Bancroft J: Androgens, behavior, and nocturnal erection in hypogonadal men: The effects of varying the replacement dose.Clinical Endocrinology. 1985,25:527–538.
Davidson JM, Cavhargo CA, Smith ER: Effects of androgen on sexual behavior in hypogonadal men.Journal of Endocrinology & Metabolism. 1979,45:955–958.
Salmimies P, Kockett G, Pirk KM: Effects of testosterone replacement on sexual behavior in hypogonadal men.Archives of Sexual Behavior. 1981,22:345–353.
O’Carroll R, Bancroft J: Testosterone therapy for low sexual interest and erectile dysfunction in men: A controlled study.British Journal of Psychiatry. 1984,145:145–151.
Pope HG, Katz DL: Homicide and near-homicide by anabolic steroid users.Journal of Clinical Psychiatry. 1990,51:28–31.
Pope HG, Katz DL: Psychiatric effects of anabolic steroids.Psychiatric Annals. 1992,22:24–29.
Phillips WN:Anabolic Reference Guide (6th Ed.). Golden, CO: Mile High Press, 1991.
Cicero TJ, O’Connor LH: Abuse liability of anabolic steroids and their possible role in the abuse of alcohol, morphine, and other substances. In Lin GC, Erinoff L (eds),Anabolic Steroid Abuse (NIDA Monograph #102). DHHS Publication No. (ADM) 90–1720. Washington DC: U.S. Government Printing Office. 1–28.
Spitzer RL, Williams JBW, Gibbon M, First M:Structured Clinical Interview for DSM-III-R (SCID). New York: Biometrics Research Division, New York State Psychiatric Institute, 1987.
Williams JBW: The Structured Interview Guide for the Hamilton Depression Rating Scale.Archives of General Psychiatry. 1988,45: 742–747.
Derogatis LR, Melisaratos M: The Brief Symptom Inventory: An introductory report.Psychological Medicine. 1983,75:595–605.
Reynolds CF, Frank E, These ME, et al: Assessment of sexual function in depressed, impotent, and healthy men: Factor analysis of a brief sexual function questionnaire for men.Psychiatry Research. 1988,24:231–250.
Endicott J, Nee J, Harrison W, et al: Quality of Life Enjoyment and Satisfaction Questionnaire: A new measure.Psychopharmacology Bulletin. 1993,29:321–326.
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Preparation of this manuscript was supported in part by NIMH Grant #MH5 2037 (Dr. J. Rabkin). Upjohn Inc. provided matched placebo and active medication.
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Rabkin, J.G., Wagner, G. & Rabkin, R. Treatment of depression in HIV+men: Literature review and report of an ongoing study of testosterone replacement therapy. Ann Behav Med 18, 24–29 (1996). https://doi.org/10.1007/BF02903936
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DOI: https://doi.org/10.1007/BF02903936