Use of Dehydroisoandrosterone in Psychiatric Practice

Having made a preliminary survey of the effect of dehydroisoandrosterone in selected cases of schizophrenia and schizoid psychopathy we decided to investigate a selected group of 11 patients who, irrespective of age, exhibited con- stitutional immaturity (especially at the emotional level) and who appeared to be inadequate but not psychotic.The patients had previously received psychiatric treatment of one sort or another, but all psychotherapy was avoided so far as possible during treatment, except in Cases 8 and 9 : inter- views were restricted to the recording of subjective and objective findings.Preliminary investigations always included a routine physical examination and urine test, and, where possible, the total 24-hour 1 7-ketosteroid out- put, together with an evaluation of the alpha and beta factors, was estimated. (In quite a number of cases the total was low, or the beta factor dim- inished.)Estimations of the white cell count, differential count, weight, and blood pressure were done in some cases before treatment, and repeated at intervals during treatment, together with a repe- tition of the total 17-ketosteroid estimation.Wherever possible a Rorschach test was carried out before treatment and repeated after a significant period of medication.Organon Laboratories supplied tablets, each con- taining 10 mg. of epi-dehydroandrosterone, the alternative chemical designation of dehydroisoandrosterone, under the trade name of " diandrone".The cases have been grouped in accordance with their type of response to treatment.Case Reports Case l.-A man, aged 36, was referred by Dr. Gould.The diagnosis was reactive depression in an immature individual of schizothymic temperament.Symptoms included lack of energy, depression, a sense of failure, *An interim report.poorly developed libido, impaired concentration, inde- cision, feelings of inferiority, shyness, lack of confidence, and apathy.He felt that he was in a mental fog and that life was hard.At his worst moments he was somewhat, but not greatly, relieved by " benzedrine ".He was treated with " diandrone ", beginning with 5 mg.daily: by the fourth day he felt more alert, more active, more " devil-may-care ", and less depressed.The dosage was increased to 5 mg.twice daily on the 18th day, by which time he was no longer requiring to force himself to perform routine duties and his friends had begun to remark on his improved attitude.Dosage was increased to 5 mg.t.i.d. on the 36th day and gradually reduced from the 78th day, by which time libido was increased, he was enjoying dancing, and had found an improvement in his social contacts and interests.His phases of depression, though present, were not disturbing him, and he was finding his work interesting instead of boring as heretofore.Approximately 14 days after reducing dosage he had two bad bouts of depression and was complaining of lack of energy.Two or three days after treatment was stopped altogether he exhibited a " rebound " phenomenon, in which he improved dramatically and felt as well as he had under treatment.This phase lasted about a week.He was then placed on a week's trial of dummy tablets, which he was told were stronger, and reported his surprise and dismay at noticing no improvement.He was given the correct tablets, again 5 mg.t.i.d., and improved at once, but