A large study (see the Cancer Network Oncology link) from Harvard Medical School and Brigham and Women’s Hospital in Boston suggests that men receiving testosterone-suppressing (hormone) therapy (ADT) for prostate cancer may be at increased risk of developing depression. The findings, published online April 11th in the Journal of Clinical Oncology, are based on Medicare records for over 78,000 U.S. men treated for prostate cancer between 1992 and 2006. Overall, 43 percent underwent hormone therapy. Once other factors were taken into account, the study found a 23% increased risk of depression compared to men receiving other cancer treatments and a 29% increased risk of inpatient psychiatric treatment. The investigators also concluded that the longer men were on hormone therapy, the greater the risk of depression. Longer exposure to hormone therapy (ADT) resulted in an increased risk of depression from 12% with less than 6 months of therapy to 26% with 7-11 months of therapy and up to 37% among patients treated for 12 months or longer. While the increased risk of depression may be a direct result of reduced testosterone levels, there could also be indirect effects such as sexual dysfunction, hot flashes and weight gain. Hormone therapy (ADT) can also be accompanied by metabolic, cardiovascular, bone and cognitive adverse events. Several prior studies have found a similar significant association between depression and ADT yet smaller studies have also shown no link. There is currently no consensus on whether ADT is associated with depression noted the authors. The study authors also stated that while hormone therapy may not be a good choice for men with “low-risk” cancers, but for “higher-risk” cancers treated by surgery or radiation, adding hormone therapy might be a good choice. For men with “intermediate-risk” prostate cancer, the benefits of hormone therapy are less clear, and would have to be weighed against the risks. Pertinent commentary from Dr. Mayer Fishman of the Moffitt Cancer Center in Tampa, FL (not Miami) was also provided in the following linked Medline article.
On a personal level, I have been on intermittent ADT for over nine years and thankfully I am asymptomatic. In light of the above, I have at times experienced very short periods of mild depression which could be due to any one of a number of causes not just ADT. More importantly however, as I approach 75 years of age, my personal relationship with God through His Son Jesus Christ and the in-dwelling Holy Spirit, allows me to retain my joy of this earthly life and the anticipation of my eternal life to come in a new heaven and a new earth with a new disease-free body. Over the years, I may have asked God the same questions as did the authors of Psalm 42. They wrote in verse 11, “Why my soul are you downcast? Why so disturbed within me? Put your hope in God, for I will yet praise Him, my Savior and my God.” I can echo the words of the Old Testament prophet Nehemiah 8:10 who states “do not be grieved, for the joy of the Lord is your strength.” Hopefully, these brief thoughts could serve as an antidote for any disease-induced depression.