Mood disorders in the context of medical illness Several studies have suggested a potential role of learn more hypogonadism in the mood symptoms and low energy present in some women with human immunodeficiency virus (HIV) infection.166-168 Trials of DHEA in women and other androgens such as testosterone in men with HIV have reported mood improvements.166,169,170 Inhibitors,research,lifescience,medical Although these reports may suggest a psychotropic effect of
gonadal steroids in these subjects, the improved mood may also reflect the anabolic effects of these steroids. Improved muscle strength and weight changes in these subjects may improve energy level and, therefore, Inhibitors,research,lifescience,medical indirectly improve mood.170,171 Potential mechanisms of antidepressant action of gonadal steroids Several mechanisms may underlie the antidepressant effects of reproductive therapies in women. First, gonadal steroid supplements may correct a pathological deficiency of a particular gonadal steroid. However, in the majority of studies
where gonadal steroids have been reported to be effective, the condition is neither associated with a particular abnormality of reproductive hormones nor are levels of reproductive Inhibitors,research,lifescience,medical hormones predictive of subsequent response to the therapeutic intervention. Nonetheless, local tissue metabolism of gonadal steroids (eg, aromatization of androgens) may produce a wide range of gonadal steroid levels within specific tissues. Thus, local and tissue-specific “relative”
deficiencies of reproductive hormones could exist and cause symptoms, but not be identified by simply measuring plasma Inhibitors,research,lifescience,medical hormone levels. Second, studies of the Inhibitors,research,lifescience,medical effects of ERT in osteoporosis172 suggest the presence of a threshold of circulating estradiol above which therapeutic effects are observed, and it is possible that a similar phenomenon (ie, critical threshold) is operational in reproductive hormone-related effects on mood. For example, in women with premenstrual syndrome, a threshold of gonadal steroid levels may exist above which mood instability occurs, and, therefore, ovarian suppression with low level gonadal steroid replacement may produce mood stability. Additionally, there may be a critical threshold of estradiol MRIP or DHEA levels below which symptoms develop in some women, and the replacement of these hormones may elevate hormone levels sufficiently to produce a mood-enhancing effect. Third, the rate of change in hormone level may convey information and trigger mood changes in women who have a differential sensitivity to increasing (eg, PM.S) or decreasing (eg, perimenopausal or postpartum depression) levels of gonadal steroids.