ADT and Depression—How common? How bad?

A recent study presented at the 2019 European Association of Urology conference reported that men who have had a prostatectomy and then go on hormone therapy are 80% more likely to be treated for depression than men who had a prostatectomy but did not go on ADT. The data are based on a retrospective look at 5,570 men in the Danish Prostate Cancer Registry. A news report on the presentation also mentioned that suicide rates are elevated for men diagnosed and treated for prostate cancer…although that wasn’t specifically tied to ADT.

Although there have been a slew of papers in which it’s reported that ADT can lead to depression, there have also been several papers claiming the opposite; i.e., that ADT is not associated with depression. The studies, however, vary in terms of the age, disease status, and treatment histories of the men.

 So how common is depression for men on ADT, and is it specifically linked to elevated suicide risk? Another recent paper looked at this for nearly 40,000 USA veterans, who had been treated with RT and then started on ADT within a year of their diagnosis. This larger study looked at a variety of demographic variables and didn’t just look at whether the men were taking medication for depression. Because of access to the Veteran’s Affairs healthcare system, the researchers had data on the patients’ use of both inpatient and outpatient medical service, plus the incidence of suicide.

 Before getting to the bottom line, it is worth noting some of the correlates that the authors flagged. For example, being of older age, coming from the Northeast USA, and having financial resources (i.e., living in communities with incomes ranging from $30,000 to $100,000) “had a protective effect against the development of depression”.  [The authors didn’t go so far as to suggest that depressed veterans on ADT move to New England.]

 Not surprising, the authors “found an association between ADT use and the development of depression.” But what is also important is they found this to be associated with outpatient services only, where the depression was treated with anti-depressant medication and/or counseling. Importantly, they found no evidence of ADT leading to increased use of inpatient psychiatric services or suicide. 

 What this says to us is that ADT does increase the risk of depression for some men, but it is typically not so severe that it can’t be treated through outpatient services like counselling and/or antidepressant medications.

For the abstract of the study by Deka and colleagues, please see:

Deka R, Rose BS, Bryant AK, Sarkar RR, Nalawade V, McKay R, Murphy JD, Simpson DR. (2019). Androgen deprivation therapy and depression in men with prostate cancer treated with definitive radiation therapy. Cancer. Apr 1;125(7):1070-1080. doi: 10.1002/cncr.31982.

To read the news article about the Danish study, please see: