Andropausia y trastornos del ánimo

Abstract

Mood disorders in older men are an important public health problem. These disorders are frequently under-diagnosed and treated due to their form of presentation with nonspecific symptoms, superposition of symptoms of medical disease, and patients’ reluctance to seek medical attention. This condition is highly lethal and is estimated to be 4 to 10 times more frequent in men than in women older than 65 years. The present article discusses some of the following questions: What is andropause? How is it diagnosed? What influence does it have on the genesis, course and treatment of mood disorders? Is there a subpopulation of men with depression who could benefit from testosterone replacement therapy? A search was performed of MEDLINE (between January 1990 and July 2005) combining the terms “hypogonadism and depression” or “testosterone and depression”. Articles referring to testosterone and depressive disorders or testosterone administration and monitoring of depressive symptoms were included. The Scielo database was searched, using the terms: “andropause and depression in the older man” to include local epidemiological data. Lastly, a search was performed of references to review articles and case reports published in the same date range. The exact role of testosterone in major depression is still not clearly defined. There is evidence to support a weak association between low testosterone levels and depressive symptoms in older men. Hypogonadism may cause poor response to antidepressants in patients with masked depression, who could benefit from short-term testosterone therapy. Further clinical studies are required to evaluate the real efficacy of testosterone in dysthymic disorder in this population.