Salivary testosterone: associations with depression, anxiety disorders, and antidepressant use in a large cohort study.
OBJECTIVE
Low circulating levels of testosterone have been associated with major depression, but there is more limited evidence for differences in patients with anxiety disorders. The use of selective serotonin reuptake inhibitors (SSRIs) and other antidepressants is associated with sexual side effects, warranting testing for interactions with testosterone.


METHODS
Data are from 722 male and 1380 female participants of The Netherlands Study of Depression and Anxiety (NESDA), who were recruited from the community, general practice care, and specialized mental health care. Depressive and anxiety diagnoses were assessed using the DSM-IV Composite International Diagnostic Interview. To smooth the episodic secretion, the four morning saliva samples per participant and the two evening samples were pooled before testosterone analysis.


RESULTS
Morning median testosterone levels were 25.2 pg/ml in men and 16.2 pg/ml in women, with lower evening levels of 18.2 and 14.1 pg/ml, respectively. Significant determinants of testosterone levels were sex, age, time of the day, use of contraceptives, and smoking status. Female patients with a current (1-month) depressive disorder (effect size 0.29; P=0.002), generalized anxiety disorder (0.25; P=0.01), social phobia (0.30; P<0.001), and agoraphobia without panic disorder (0.30; P=0.02) had lower salivary testosterone levels than female controls. Higher testosterone levels were found in male and female participants using SSRIs than in non-users (effect size 0.26; P<0.001).


CONCLUSIONS
Salivary testosterone levels are lower in female patients with a depressive disorder, generalized anxiety disorder, social phobia, and agoraphobia as compared to female controls. SSRIs may increase salivary testosterone in men and women.
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands. e.j.giltay@lumc.nl
Erik J
EJ
Giltay
Dorien
D
Enter
Frans G
FG
Zitman
Brenda W J H
BW
Penninx
Johannes
J
van Pelt
Phillip
P
Spinhoven
Karin
K
Roelofs
D000328:Adult; D000367:Age Factors; D000379:Agoraphobia / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism*; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D015331:Cohort Studies; D003270:Contraceptive Agents / Q000009:adverse effects / Q000378:metabolism; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory; D010698:Phobic Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism*; D011569:Psychiatric Status Rating Scales; D011603:Psychophysiology; D012463:Saliva; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000378:metabolism; D013739:Testosterone / Q000032:analysis / Q000378:metabolism; D013997:Time Factors
D000928:Antidepressive Agents; D003270:Contraceptive Agents; D017367:Selective Serotonin Reuptake Inhibitors; D013739:Testosterone