Emotional Lability Secondary to Androgen Deprivation Therapy for Prostate Cancer: A Case Report

AIMS: Prostate cancer accounts for more than a quarter (27%) of male cancer cases, making it the most common form of cancer in UK males. Androgen deprivation therapy (ADT) is the mainstay of treatment for prostate cancer. Its aim is to reduce the level of androgens which stimulate cancer cell growth, in turn reducing prostate cancer symptom burden over longer periods. Although the clinical benefits of androgen deprivation therapy have been well documented, the physical, and in particular psychological, side effects of this treatment are lesser reported and can be debilitating. METHODS: We present the case of an 84 year old male referred to Old Age Psychiatry outpatients for a one year history of low mood and tearfulness with no response to two antidepressant trials. The patient was receiving six-monthly injections of Decapeptyl (Triptorelin), a hormone therapy for prostate cancer. The patient's main presenting complaint was of bouts of tearfulness that were difficult to control and often mood incongruent. He reported low energy and reduced motivation; however other biological depressive symptoms were not endorsed. RESULTS: Depression and marked emotional lability have been reported by men who receive ADT for prostate cancer. This can be a cause of confusion or shame for patients, subsequently impacting interpersonal relationships and social functioning. Other side effects of ADT can lead to further negative psychological effects, including weight gain, gynaecomastia and genital shrinkage. It is possible that the side effects of this treatment are poorly recognized by clinicians initiating and managing it. CONCLUSION: In conclusion, patients commencing ADT should be informed of the possibility of psychological side effects and encouraged to report any symptoms that arise. It is important for urologists, psychiatrists and GPs to be mindful of the possible link between this treatment and new onset mood and emotional symptoms in patients.