Characteristics of depression treatment in men with testosterone deficiency

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Abstract

BACKGROUND: Treatment of depression in men with testosterone deficiency is particularly challenging because of the overlap between the symptoms of depression itself and those associated with testosterone deficiency, which requires the development of additional diagnostic and therapeutic approaches.

AIM: To enhance the effectiveness of comprehensive treatment of depression in men with testosterone deficiency.

MATERIALS AND METHODS: The study involved 140 male participants (aged 18–65 years) diagnosed with depressive episodes and recurrent depressive disorder according to the International Classification of Diseases, 10th revision. Patients were divided into the main group (testosterone levels below 12.1 nmol/l) and the control group (normal testosterone levels). The main group (n=90) was further divided into three therapeutic subgroups of 30 patients each: receiving sertraline monotherapy, testosterone monotherapy, and combined sertraline and testosterone treatment. The control group included men with depression and normal testosterone levels (n=50), who received sertraline only.

RESULTS: Depression in men in the context of testosterone deficiency has distinct clinical features, both phenomenologically and syndromally. The severity of the depressive syndrome in men with testosterone deficiency is lower (17.0 [16.0; 18.75] points on the HDRS scale) than in patients with normal testosterone levels (19.0 [18.0; 22.0] points on the HDRS scale), and the depressive episode tends to occur later in life (47.0 [42.0; 55.0] years) compared to those with normal levels of testosterone (29.5 [24.25; 40.0] years) and is less likely to be recurrent than in those with normal testosterone levels (29.5 [24.25; 40.0] years). The study of the efficacy and safety of depression therapy in the context of testosterone deficiency shows that a combined approach to the treatment of depression in men with testosterone deficiency has both advantages (considering the specifics of patients by normalizing testosterone levels and erectile function) and disadvantages (relatively higher risk of adverse events) compared to sertraline monotherapy.

CONCLUSION: The identified characteristics of the course and treatment of depression in the context of reduced testosterone levels allowed for the development of a more effective therapeutic and diagnostic algorithm.

About the authors

Yuriy Yu. Osadshiy

Rostov State Medical University

Author for correspondence.
Email: osadshiy@mail.ru
ORCID iD: 0000-0001-5116-8397
SPIN-code: 8593-8557

Junior Researcher, Depart. of Psychiatry and Narcology

Russian Federation, Rostov-on-Don

Svetlana V. Soldatkina

Rostov State Medical University

Email: osadshiy@mail.ru
ORCID iD: 0000-0002-2478-0537

Student, Faculty of Medicine and Prevention

Russian Federation, Rostov-on-Don

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2. Fig. 1. Study design.

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3. Fig. 2. Differences in the levels of depression (p <0.001) and anxiety (p=0.082) in depressed patients against the background of reduced (main subgroup) and normal (control subgroup) testosterone levels; HDRS — Hamilton Depression Rating Scale; HARS — Hamilton Anxiety Rating Scale.

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4. Fig. 3. Dynamics of depression level according to the Hamilton Depression Rating Scale (HDRS) against the background of treatment with different schemes in patients with depression on the background of reduced testosterone level (MG-1 — the first experimental subgroup, MG-2 — the second experimental subgroup, MG-3 — the third experimental subgroup) and control group; p — statistical significance of differences in all subgroups on the day of the visit according to the Kraskell–Wallis test.

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5. Fig. 4. Dynamics of anxiety level in depressed patients with testosterone deficiency according to Hamilton Anxiety Rating Scale (HARS) on the background of treatment with different schemes (MG-1 — the first experimental subgroup, MG-2 — the second experimental subgroup, MG-3 — the third experimental subgroup) and in control group patients; p — statistical significance of differences in all subgroups on the day of the visit according to the Kraskell–Wallis criterion.

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6. Fig. 5. Testosterone level control in depressed patients with testosterone deficiency in control group patients during the first and last visits. In pairwise comparison of testosterone levels, statistically significant differences were found between the subgroup of patients treated with the combination treatment and the subgroup treated with antidepressant alone (p=0.036) by the 6th visit; MG-1 — first experimental subgroup; MG-2 — second experimental subgroup; MG-3 — third experimental subgroup.

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7. Fig. 6. Algorithm of work with patients suffering from depression on the background of testosterone deficiency; AEs — adverse events; HDRS — Hamilton Depression Scale; HARS — Hamilton Anxiety Scale; IIEF — International Index of Erectile Function.

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