The prevalence of depression, erectile dysfunction (ED) and coronary heart disease (CHD) increase as we age. In general, doctors tend to consider them as separate entities partly because of specialization in their respective fields like Urology or Endocrinology or Cardiology. Male patients presenting with problems with one organ system may have comorbid states in another organ system. At times, the other comorbid state may already be known to the patient himself and he may choose not to discuss the issue. The National Institute of Health recognized ED as a medical identity following a Consensus Development Conference in 1992, but it was not till the introduction of specific type 5 phosphodiesterase inhibitors (e.g. Viagra) that men started seeking help with ED in larger numbers. This is like depression in that before readily available and safe ED treatments were available, patients just shunned treatments or were treated inappropriately. The symptoms related to depression, ED and CHD are closely interlinked. Aman presenting with symptoms of depression may have comorbid ED and/or comorbid CHD. Likewise, an older man that presents with ED may have underlying CHD and may at the same time be depressed.
We were the first to describe a condition “DEC Syndrome” in a paper in 2003. It is a simple acronym to remember this entity of Depression, Erectile Dysfunction, Coronary Heart Disease. We urged doctors to screen for the other 2 components of the DEC syndrome when the patient presents with one component. The root cause of the DEC syndrome may be a combination of arteriosclerosis, neurochemical imbalance and hypogonadism that occurs with aging. The timing of the symptoms of the syndrome coincides with hypogonadism in the andropause.Although testosterone replacement may improve depression, it should not be the first line of treatment. Likewise, although testosterone may improve coronary flow,patients with coronary problems should not be offered testosterone as first line therapy, but may be offered supplementary testosterone if there is hypogonadism and there are no contraindications. There is considerable overlap in each component. At the Opal Medical Clinic, we are one of the pioneers in the concept of screening for other medical illness in the presence of erectile dysfunction treatment in Houston. We are into not only treating the disease state, but a complete wellness program.
Reference: Tan RS, Pu SJ. The interlinked depression, erectile dysfunction, and coronary heart disease syndrome in older men: a triad often underdiagnosed.J Gend Specif Med. 2003;6(1):31-6.