Depression in Dhat Syndrome

Abstract

Dhat syndrome is a widely recognized clinical condition in the Indian subcontinent characterized by excessive preoccupation with semen loss as the main presenting complaint. This condition has been considered to be a culture-bound syndrome, and depressive symptoms have previously been reported. We were interested to know how common depression is, and to quantify these features. We studied 30 patients attending the Psychiatry Outpatient Department of a tertiary care hospital for their complaints about passing of semen in urine frequently. Those with depressive symptoms were further evaluated using the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Diagnostic Criteria for Depression, and depression severity was assessed using the 17-item Hamilton Depression Rating Scale for Depression (HAM-D). Patients meeting the criteria were started on capsule fluoxetine, a selective serotonin reuptake inhibitor, in dose of 20-40 mg per day. Patients were periodically followed fortnightly and were reevaluated for therapeutic response using the HAM-D. A total of 30 patients (age = 20-40 years; mean age = 29 years; mean age of onset = 19 years; mean duration of illness = 11 months) were studied. The majority of cases were unmarried (64.2%) and educated till 5th class or above (70%). Twenty out of 30 (66%) patients met DSM-IV Diagnostic Criteria for Depression. Ten patients (33.3%) were found to have a comorbid problem of premature ejaculation, and two patients reported erectile dysfunction (6.6%). Patients showed statistically significant therapeutic response to fluoxetine. Depressive phenomenology meeting DSM-IV Diagnostic Criteria for Depression seems common in Dhat syndrome and responds to selective serotonin reuptake inhibitors along with regular counseling.