DHEA Helps You Keep Your Mind

DHEA for an Even Mental Keel

DHEA Helps You
Keep Your Mind

Natural hormone known for its antidepressant action is effective even in schizophrenia
By Will Block

A mind is a terrible thing to . . . uh . . . whatever.
—The Fusco Brothers comic strip

n the current edition of a well-known dictionary, there appears the following usage example for the word schizophrenia: “the national schizophrenia that results from carrying out an unpopular war.” How timely. Not only is the country as a whole divided by opposing positions, but many individuals are themselves unsure of where they stand, or should stand, on this momentous issue. Torn between the conflicting views of hawks and doves (and what does that make them—turkeys?), they exist in a moral muddle of doubts and fears.

Feeling hopelessly conflicted about a situation characterized by disparate or antagonistic elements is what we refer to, in common parlance, as being schizophrenic. Common parlance, however, is not the language of science. Here’s what schizophrenia really is (quoting from the dictionary again): “Any of a group of psychotic disorders usually characterized by a withdrawal from reality, illogical patterns of thinking, delusions, and hallucinations, and accompanied in varying degrees by other emotional, behavioral, or intellectual disturbances. Schizophrenia is associated with dopamine imbalances in the brain and defects of the frontal lobe and is caused by genetic, other biological, and psychosocial factors.” Whew! That covers a lot of territory.

Schizophrenia Is a Big Problem

Schizophrenia is a major public health problem throughout the world, affecting about 1% of the population, although pockets of higher or lower incidence have been identified. In the United States, people with schizophrenia occupy about one-fourth of all the hospital beds and account for about one-fifth of all Social Security disability days.1 Schizophrenia is more prevalent than Alzheimer’s disease, diabetes, or multiple sclerosis.

With so many people affected by schizophrenia, it’s no wonder there are so many shrinks being kept busy listening to people talk their ears off. While psychotherapy has an important place in the vast domain of health-care practice, especially if the practitioner is highly skilled, there are other, less artful but more scientifically sound, means of treating schizophrenia (and many other mental disorders as well). Take another look at that definition above, and note the words, “associated with dopamine imbalances in the brain.” What does that suggest—that schizophrenia is “all in the mind”? Only if the mind is some disembodied abstraction unrelated to molecules, and not governed by the laws of physics and chemistry.

The Molecules of Your Mind Can Drive You Crazy

Everything that science has discovered about the mind suggests that it’s the sum total of an immensely complex system of biochemical reactions—no more, no less—occurring ceaselessly in the brain, which is made up exclusively of . . . molecules. Every thought, feeling, idea, impulse, emotion, sensation, etc., can be traced—in principle, and sometimes in actual fact—to a series of reactions involving specific molecules. About many of these molecules we know a great deal; about others we know very little. And many, surely, have not even been discovered yet, let alone analyzed as to what they do and how they do it.

A Beautiful Mind

You may have read the book or seen the movie by that title. It’s an amazing story, made all the more so because it’s true. John Forbes Nash, Jr., a mathematical genius at Princeton University, succumbed to schizophrenia while still a young man at the height of his intellectual powers. His life became a living hell of paranoid delusions and hallucinations. Medical treatments that were tried on him didn’t work, and he refused other treatments that might have worked. The hell dragged on for over three decades and probably would have lasted until the end of Nash’s life, but for one thing: his was no ordinary sick mind.

Over the years, it slowly, painfully dawned on Nash that he was crazy, that the bizarre things he had believed in and acted on for so long were not real, but the products of a diseased brain—his own. In an astounding feat of self-healing, Nash willed himself out of his schizophrenia by the power of pure thought—he reasoned his way from the darkness back into the light. Like the brilliantly original contributions he had made to the mathematics of game theory (for which he won the Nobel Prize in Economics in 1994), his achievement in freeing himself from the terrible prison of his own mind was simply . . . beautiful.

One of the brain molecules we do know a good deal about is dopamine, a common neurotransmitter that is essential to the normal functioning of the central nervous system. Imbalances in dopamine levels (e.g., too much here, or too little there) and imbalances in dopamine activity (e.g., neuronal receptor sites that are either too sensitive to dopamine or not sensitive enough) can wreak all kinds of mental havoc. They can drive you crazy—literally.

That we know about the molecular mechanisms of some mental diseases, at least, and that we can treat them with pharmaceutical agents, is proof that the human mind is no abstraction, but rather a manifestation of the brain’s molecular composition and dynamics. We can think of it as a kind of molecular symphony that makes beautiful mental music—most of the time. Sometimes, though, a few instruments go haywire and start playing the wrong notes, with discordant results. When that happens, we can often (but not always) retune those instruments and restore harmony—more or less.

Antipsychotic Drugs Can Work but Are Dangerous

The standard medical approach is to use antipsychotic drugs, which are designed to affect brain function by either enhancing or inhibiting some targeted biochemical mechanism—often, however, at the price of very serious side effects. This is true of the conventional antipsychotic drugs, all of which act in essentially the same way: they block dopamine receptors in the brain, thus inhibiting excessive dopamine activity, which is associated with psychotic symptoms. (Serious reductions in brain dopamine levels are associated with Parkinson’s disease, but that’s another story.)

A newer class of antipsychotic drugs goes one step further: these compounds block not only dopamine receptors but serotonin receptors as well; they have such dangerous (potentially fatal) side effects, however, that they are used only in severe cases, when conventional drugs have failed.

Orthomolecular Medicine Is Natural and Safe

Another approach—and this is going to sound a lot more attractive—is to treat the patient with compounds that are natural constituents of the human body in the first place, in an attempt to correct the molecular imbalances or deficiencies that may be causing the disease. This approach is called orthomolecular medicine, a concept pioneered by Linus Pauling based on his profound understanding of the nature of complex biochemical systems and the physical laws that make them work. His interest in this field was focused mainly on mental disorders, where the approach is called orthomolecular psychiatry. Let us now look at an example of it.

DHEA Helps Fight Depression

A group of psychiatrists in Israel were intrigued by various research results obtained with DHEA (dehydroepiandrosterone), which is by far the most abundant steroid hormone in the human body. (DHEA is a precursor to a variety of other hormones, including the male and female sex hormones.) It had been reported in 1994 that DHEA improves memory, mood, and a sense of well-being in older people.2 These claims have not been confirmed by other studies, however, and a much more rigorous study conducted in 2001 found no evidence to support them—at least not in normal (i.e., not depressed or otherwise afflicted) older men.3*


*Whether this would be true of normal older women is an open question. It is well known that men and women metabolize DHEA very differently, and DHEA affects men and women differently in a number of ways. For more on this subject, as well as an overview of DHEA’s varied health benefits, see “DHEA: The Most Versatile Hormone,” in Life Enhancement, February 2001.)


On the other hand, there is credible evidence that DHEA provides benefits to people suffering from dysthymia (a mood disorder associated with mild depression),4 and even from severe depression.5 That being true, the Israeli researchers reasoned that DHEA might also be helpful in cases of schizophrenia that are characterized mainly by so-called negative symptoms, which are similar in some ways to those of depression. (See the sidebar “All About Schizophrenia.”)

All About Schizophrenia

Well, not all—just a bit. Some researchers believe that schizophrenia is a single disorder. Others believe it’s a constellation of disorders with a number of subtypes, and they have different ways of categorizing them. It all seems kind of . . . schizophrenic.* The simplest breakdown (so to speak) is between schizophrenias characterized by what might be called positive symptoms (in the sense that they go beyond normal behavior) and schizophrenias characterized by negative symptoms (in the sense that various aspects of normal behavior are absent).

Positive symptoms are those such as delusions, hallucinations, thought disorders (typically evidenced by disorganized or incoherent speech), and bizarre behaviors (e.g., childlike silliness, agitation, or inappropriate appearance, hygiene, or conduct). The first two of these symptoms, delusions and hallucinations, are the dominant characteristics of paranoid schizophrenia, a particular form of nondeficit schizophrenia. Overall, people with nondeficit schizophrenia tend to be less severely disabled and more responsive to treatment than those with the other kind.

The other kind, deficit schizophrenia, is characterized by negative symptoms, such as flattened emotions, lack of motivation, and a diminished sense of purpose. Such people tend to be conspicuously uncommunicative and unexpressive of normal emotions (e.g., they neither laugh nor cry when normal people probably would); they have a diminished capacity to experience pleasure; they take little interest in previous activities and spend more time on pointless ones; and they show little interest in interpersonal relationships. It’s terribly sad—but it’s encouraging to know that DHEA can be helpful to such people.


*In any case, don’t expect to see any mention here of “split personality” as a common manifestation of schizophrenia. Scientists no longer give credence to that simplistic notion (even though the word itself means “split mind”).

DHEA Improves Symptoms of Schizophrenia

The Israeli group tested DHEA in a randomized, double-blind, placebo-controlled study, using 27 long-term institutionalized schizophrenic patients (15 men and 12 women, average age 37), all of whom were also taking conventional antipsychotic drugs.6

The patients were given DHEA or placebo orally according to the following schedule: 25 mg/day for the first 2 weeks; 50 mg/day in two equally divided doses for the second 2 weeks; and 100 mg/day in two equally divided doses for the last 2 weeks. As in previous studies with DHEA, these dosages were selected to increase the patients’ circulating DHEA levels to the range of the typical physiological peak in healthy people in their twenties. (After that youthful peak, DHEA levels decline at the rate of about 10% per decade, a loss that may contribute significantly to the aging process. See “DHEA—The Hormone of Youth?” in Life Enhancement, December 2002.)

Using a battery of five standardized tests of mental and behavioral function, the researchers evaluated the patients at baseline (the outset of the study) and every week thereafter for the 6-week duration. (They also measured the patients’ blood levels of DHEA.) In four of the five tests, the patients receiving DHEA showed significant improvement in negative, depressive, and anxiety symptoms of schizophrenia compared with the patients taking placebo; in the fifth test, the DHEA patients did better than the controls, but the difference was not statistically significant. These results—the first of their kind in a double-blind study—are most encouraging (they’re marred only by some slipshod reporting of the data, which contain internal contradictions).

Women Benefit More than Men

The observed improvements correlated with the measured blood levels of DHEA: by and large, the greater the increase in blood DHEA levels, the greater the improvement. This provided additional evidence that the improvements observed were genuine, not apparent. Interestingly, the improvements were generally more pronounced in the women than in the men—yet another confirmation of the fact that DHEA is often gender-specific in its actions. No adverse effects of the DHEA treatment were reported, and there have been no reports of adverse interactions between DHEA and antipsychotic drugs.

How did DHEA exert its effect on these patients? The researchers offered speculations involving possible actions with respect to a number of different neurotransmitters, but the upshot is that they don’t know. As always, further research is needed—not just to shed more light on that question but also to expand the parameters of the Israeli study to encompass larger numbers of patients under more tightly controlled conditions (e.g., by using patients who are all on the same antipsychotic drug, rather than eight different drugs, as in this study).

Don’t Go Crazy—Go DHEA

If you can’t make up your mind about whether or not you support the war, whether or not the laws of physics are really the same throughout the entire universe, or whether or not chocolate is even better than sliced bread, the important thing is to get a grip and hang on. Keep coping with whatever uncertainties and conflicts life throws at you. Don’t get depressed, and don’t go crazy! It could be that taking enough DHEA to make up for what Father Time has robbed you of can help you stay on an even keel. Wrap your mind around that thought.

References

  1. Berkow R, et al., eds. The Merck Manual of Medical Information—Home Edition. Pocket Books, New York, 1997, p. 435.
  2. Morales AJ, Nolan JJ, Nelson JC, Yen SS. Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age. J Clin Endocrinol Metab 1994 Jun;78(6):1360-7. Erratum: J Clin Endocrinol Metab 1995 Sep;80(9):2799.
  3. van Niekerk JK, Huppert FA, Herbert J. Salivary cortisol and DHEA: association with measures of cognition and well-being in normal older men, and effects of three months of DHEA supplementation. Psychoneuroendocrinology 2001;26:591-612.
  4. Bloch M, Schmidt PJ, Danaceau MA, Adams LP, Rubinow DR. Dehydroepiandrosterone treatment of midlife dysthymia. Biol Psychiatry 1999;45:1533-41.
  5. Wolkowitz OM, Reus VI, Keebler A, Nelson N, Friedland M, Brizendine L, Roberts E. Double-blind treatment of major depression with dehydroepiandrosterone. Am J Psychiatry 1999 Apr;156(4):646-9.
  6. Strous RD, Maayan R, Lapidus R, Stryjer R, Lustig M, Kotler M, Weizman A. Dehydroepiandrosterone augmentation in the management of negative, depressive, and anxiety symptoms in schizophrenia. Arch Gen Psychiatry 2003 Feb;60:133-41.



Will Block is the publisher and editorial director of Life Enhancement magazine.

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