Correspondence

Major Depressive Disorder

N Engl J Med 2008; 358:1868-1869April 24, 2008

Article

To the Editor:

In their review article, Belmaker and Agam (Jan. 3 issue)1 examine several mechanisms involved in depressive disorders, but they do not mention evidence that androgen-deprivation therapy, which is frequently used in the management of prostate cancer, can cause major depression.2 The mechanisms underlying this association may include loss of sexual potency, fatigue, cognitive impairment, and changes in body composition, which lead to deterioration of a patient's perception of his body.3 A direct effect of testosterone, however, cannot be ruled out. A cross-sectional study of the relation between testosterone levels and depressive symptoms in 856 community-dwelling older men showed that depression was inversely associated with bioavailable testosterone independently of age, weight change, and physical activity.4 Bioavailable estradiol was not associated with depressed mood.

Andrea Saini, M.D.
San Luigi Gonzaga Hospital, 10043 Orbassano, Italy

Mara Ardine, M.D.
San Lorenzo Hospital, 1022 Carmagnola, Italy

Alfredo Berruti, M.D.
University of Turin, 10043 Orbassano, Italy
alfredo.berruti@gmail.com

4 References

1. 1

   Belmaker RH, Agam G. Major depressive disorder. N Engl J Med 2008;358:55-68
   Full Text | Web of Science | Medline

2. 2

   Pirl WF, Siegel GI, Goodie MJ, Smith MR. Depression in men receiving androgen deprivation therapy for prostate cancer: a pilot study. Psychooncology 2002;11:518-523
   CrossRef | Web of Science | Medline

3. 3

   Berruti A, Dogliotti L, Terrone C, et al. Changes in bone mineral density, lean body mass and fat content as measured by dual energy x-ray absorptiometry in patients with prostate cancer without apparent bone metastases given androgen deprivation therapy. J Urol 2002;167:2361-2367
   CrossRef | Web of Science | Medline

4. 4

   Barrett-Connor E, Von Muhlen DG, Kritz-Silverstein D. Bioavailable testosterone and depressed mood in older men: the Rancho Bernado Study. J Clin Endocrinol Metab 1999;84:573-577
   CrossRef | Web of Science | Medline

To the Editor:

Belmaker and Agam indicate that a person must feel sad to be depressed. The American Medical Association monograph Major Depressive Disorder in Primary Care 1 notes on page 5 that many depressed people do not feel blue but instead present with symptoms such as “fatigue, insomnia, gastrointestinal distress or musculoskeletal pain.” On page 4, it is noted that depression is correctly diagnosed by primary care physicians at the time of presentation in only 22% of patients who present with primarily physical symptoms.

Thomas C. Long, M.D.
Thomas C. Long and Associates, South Barrington, IL 60010
tomclong@comcast.net

1 References

1. 1

   Major depressive disorder in primary care. Chicago: American Medical Association, December 2003:4-5.