DHEA
DHEA (5-Dehydroepiandrosterone) is a natural steroid produced in the adrenal glands, the gonads and the brain. It is the most abundant circulating steroid in humans. A form of DHEA, 7-keto DHEA (3-acetyl-7-oxodehydroepiandosterone), is claimed to have fewer side effects. DHEA is involved in a range of biological effects and may cause some problematic hormonal side effects. The newer form (7-keto DHEA) may be safer, but research on its effectiveness and its side effects is extremely limited. DHEA supplementation may help with depression, but it has a long list of potential side effects and drug interactions. MHA cautions against use of DHEA, cautiously recommends 7-keto DHEA as an alternative to DHEA pending further testing, and counsels getting the help of a skilled health care practitioner, especially if using any other drugs or herbs.
Mental Health Implications
Mood Disorders
Only two of the four sources that discuss DHEA are unambiguous in supporting its use for treatment of depression. Most sources do not mention DHEA for depression. All sources advise caution because of the risks.
Bipolar Disorder
DHEA should be used with caution and in lower doses in people with bipolar disorder. DHEA may exacerbate mania, irritability and aggression. Leading researchers (Mischoulon and Rosenbaum) recommend that people taking DHEA should be regularly monitored for occasional development of aggressive or disinhibited behavior.
PTSD
Case reports showed promising possibilities for the effects of 7-keto DHEA on PTSD; however, there are still inadequate clinical studies supporting this use.
Schizophrenia
Two trials of DHEA treatment in people with schizophrenia showed a reduction in negative symptoms, and experts theorize that there may be a deeper connection. But there isn't enough research to show that DHEA is particularly promising or effective for this use.
Cognition
Recent trials do not support the use of DHEA for neuroprotection.
7-KETO DHEA
7-keto-DHEA is a byproduct of DHEA. But unlike DHEA, 7-keto-DHEA is not converted to steroid hormones such as androgen and estrogen. Taking 7-keto-DHEA by mouth or applying it to the skin does not increase the level of steroid hormones in the blood. Thus, 7-keto DHEA deserves study to determine whether it has the same efficacy as DHEA without the hormonal side effects.
Drug Interactions
If you are considering taking or continuing to take DHEA or 7-keto DHEA, you should definitely consult with a skilled health care practitioner. It is critical to consult with your prescribing physician if you are taking any psychotropic medication.
DHEA may interfere with a wide variety of prescription medications, over-the-counter medications, and other herbal supplements. DHEA may also interact with a recent flu vaccination or with alcohol consumption. As a result, great care should be taken before supplementing DHEA levels. No prescription medication should be taken with DHEA without consulting with the prescribing physician. The following list is illustrative only.
Interactions include potential interference with:
- Other steroids;
- Psychotropic drugs such as clozapine (Clorazil);
- Medications and herbs that affect blood sugar levels;
- Anticoagulant or anti-platelet drugs (those that thin the blood), such as warfarin Coumadin), hepadrin or clopidogrel, or herbs with similar effects, such as ginseng;
- Hormone replacement therapy and birth control pills, as well as herbs that have hormonal effects, such as alfalfa and blood root;
- Heart medications or herbs that alter heart rhythms;
- Any medication that may increase DHEA levels in the body, including growth hormones and aprazolem (Xanax), antipsychotics, and pain killers, as well as supplements like chromium.
Studies have not yet been conducted to determine whether the same interactions exist with 7-keto DHEA.
Side Effects
- May increase the risk of developing prostate, breast, ovarian, uterine, or cervical cancer and malignant melanoma or other hormonally-affected cancers.
- Hormonal side effects can be significant, including acne, skin changes, excess hair or hair loss, increased sweating, and weight gain.
- Men may develop more prominent breasts, breast tenderness, increased blood pressure, testicular wasting, significant elevations in testosterone levels with potential effects on the prostate, and increased aggressiveness.
- In women, the most common side effects are abnormal menses, emotional changes, headache, and insomnia.
- Additional hormonal side effects may include increases in blood sugar levels, insulin resistance, altered cholesterol levels, altered thyroid hormone levels, and altered adrenal function.
- Can lead to insomnia.
- May affect blood sugar levels. People with severe diabetes should not use DHEA; others should monitor blood sugar levels carefully.
- May increase the risk of bleeding or blood clotting.
- May alter heart rate or rhythms.
- May cause fatigue, nasal congestion, headache, acne, and rapid and irregular heartbeat.
- May cause agitation, delusions, nervousness, irritability, or psychosis and may induce hypomanic, aggressive, psychotic, or disinhibited behavior.
- In people with bipolar disorder, DHEA should be used with caution and only in low doses because it can exacerbate mania, irritability, and aggression.
- People with a history of abnormal heart rhythms, blood clots or problems with clotting, or a history of liver disease, serious diabetes or hyperglycemia, high cholesterol, thyroid disorders, or other serious endocrine (hormonal) abnormalities should avoid DHEA
- Children should not use DHEA, nor should it be used during pregnancy or breast feeding.
While 7-keto DHEA may not cause the same hormonal side effects, there isn't enough research to prove its efficacy or side effects.
Conclusion
Each consumer needs to make a risk-versus-reward decision about DHEA. MHA urges caution because the evidence of efficacy is weak and the potential side effects and drug interactions are significant. More study is needed before 7-keto DHEA can be recommended as an alternative, but it may be prudent to consider it prior to studies substantiating the claims being made, in order to reduce risk.
For detailed information on DHEA and other treatments, download the full review.