Treatment of depression in HIV+ men: Literature review and report of an ongoing study of testosterone replacement therapy

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 clearcut 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 no: statistically significant. These findings suggest that testosterone replacement therapy has significant antidepressant effects for men with significant immunodeficiency and clinical manifestations of hypogonadism.