If there was any doubt that ADT increases the risk of depression, this new review article pretty much shuts down the discussion. To quote the authors, ADT “not only worsens pre-existing depressive symptoms, but may also trigger development of clinical depression in patients after a treatment run-in period of approximately 1 yr.”
As for cognitive effects, the authors report “an association between ADT and subtle cognitive impairment, particularly memory, as early as 6 mo after initiating ADT.” They further found some evidence for a slight increase in the risk of dementia, which was greater the longer the patients were on ADT.
There are lots of other bits of interesting discussion in this review article on the neuropsychiatric impact of ADT. For example, the authors report that ADT does not increase the risk of suicide. That’s good news. The authors note, though, that the greatest risk of suicide for prostate cancer patients is among white, unmarried, and older men, with the risk increasing as the length of time since diagnosis increases.
The authors suggest that "depression may amplify feelings of loss of masculinity”. Unfortunately they do not discuss what defines masculinity, although they recognize that having a strong sex drive (libido) may be a component. As such, the relationship between depression and “feelings of loss of masculinity” on ADT work in the opposite direction from what the authors propose. In other words, instead of depression contributing to a loss in how masculine one feels, the sense of masculinity may itself be grounded in the ability to function sexually as a male (as other researchers have proposed). In that case, it is that loss of sexual function that leads to depression.
The paper ends with a strong recommendation that "all patients starting ADT should be counselled regarding possible neuropsychiatric side effects, including information about the connection between ADT and mental health…" Although they don't mention the ADT Educational Program, the ADT book and class provide that preemptive counselling.
To read the study abstract, see: https://pubmed.ncbi.nlm.nih.gov/32690473/
Siebert AL, Lapping-Carr L, Morgans AK. Neuropsychiatric Impact of Androgen Deprivation Therapy in Patients with Prostate Cancer: Current Evidence and Recommendations for the Clinician [published online ahead of print, 2020 Jul 17]. Eur Urol Focus. 2020;S2405-4569(20)30149-8.