Does Finasteride cause depression

Introduction

Finasteride, a 5α-reductase inhibitor, is commonly used to treat androgenetic alopecia (male pattern hair loss) and benign prostatic hyperplasia. However, there have been concerns about its potential psychiatric side effects, particularly depression. This synthesis aims to analyze the existing research to determine whether finasteride causes depression.

Key Insights

Depressive Symptoms and Suicidal Thoughts in Former Users:
- Former users of finasteride with persistent sexual side effects reported significantly higher rates of depressive symptoms and suicidal thoughts compared to controls .
Depression During Treatment:
- A retrospective study reported that 19 out of 23 patients developed moderate to severe depression during finasteride treatment, which resolved after discontinuation. However, another review criticized the diagnostic criteria used in this study, suggesting the term "depression" might be misleading.
Neuroactive Steroid Levels:
- Altered levels of neuroactive steroids in cerebrospinal fluid and plasma were observed in post-finasteride patients, which may be linked to depressive symptoms .
Animal Studies:
- In male rats, finasteride treatment led to long-term depressive-like behavior, neuroinflammation, and changes in gut microbiota composition.
Meta-Analysis and Systematic Reviews:
- A systematic review and meta-analysis found that finasteride treatment is associated with a higher risk of depressive symptoms and suicidal ideation compared to non-users.
Case Series and Pharmacovigilance Data:
- Case series and pharmacovigilance data indicate a significant association between finasteride use and psychological adverse events, including depression and suicidality, particularly in younger patients using the drug for alopecia .

Conclusion

The collective evidence suggests that finasteride is associated with an increased risk of depressive symptoms and suicidal thoughts, particularly in individuals with persistent sexual side effects and younger patients using the drug for hair loss. Alterations in neuroactive steroid levels may play a role in these psychiatric effects. Further controlled studies are needed to establish a definitive causal relationship.

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Does Finasteride cause depression

Summary

Consensus Meter

Introduction

Key Insights

Conclusion

Sources and full results

Treatment of male rats with finasteride, an inhibitor of 5alpha-reductase enzyme, induces long-lasting effects on depressive-like behavior, hippocampal neurogenesis, neuroinflammation and gut microbiota composition

Finasteride treatment in male rats has long-lasting effects on depressive-like behavior, hippocampal neurogenesis, neuroinflammation, and gut microbiota composition.

Depression Circumstantially Related to the Administration of Finasteride for Androgenetic Alopecia

Finasteride treatment for androgenetic alopecia may cause moderate to severe depression, impairing sociofamilial relations, sleep, and eating behavior, but resolves quickly after discontinuing the drug.

Depressive symptoms and suicidal thoughts among former users of finasteride with persistent sexual side effects.

Former finasteride users with persistent sexual side effects are at a higher risk of depressive symptoms and suicidal thoughts.

Response to Article “Depression Circumstantially Related to the Administration of Finasteride for Androgenetic Alopecia” (J Dermatol, 29, 665–669, 2002)

Finasteride administration for androgenetic alopecia may cause depression, but the study's methodology and conclusions need further investigation.

Risk of Depression Associated With Finasteride Treatment

Finasteride treatment is associated with increased risk of depression, suicidal ideation, and sustained sexual dysfunction, even after discontinuing treatment.

Neuroactive steroid levels are modified in cerebrospinal fluid and plasma of post-finasteride patients showing persistent sexual side effects and anxious/depressive symptomatology.

Post-finasteride patients with androgenic alopecia still experience depression symptoms and persistent sexual side effects, despite discontinuing treatment.

Patients treated for male pattern hair with finasteride show, after discontinuation of the drug, altered levels of neuroactive steroids in cerebrospinal fluid and plasma

Finasteride treatment for male pattern hair loss can lead to altered neuroactive steroid levels, causing depression symptoms in patients even after discontinuing the drug.

Cognitive effects of testosterone and finasteride administration in older hypogonadal men

Testosterone and finasteride administration in older hypogonadal men showed small improvements in depressive symptoms and visuospatial memory, but no major cognitive improvements were observed.

Finasteride and Suicide: A Postmarketing Case Series

Men under 40 who use finasteride for alopecia may be at risk for suicide if they develop persistent sexual adverse effects and insomnia.

Investigation of Suicidality and Psychological Adverse Events in Patients Treated With Finasteride.

Finasteride use is associated with increased suicidality and psychological adverse events in patients younger than 45 years who use it for alopecia, but not in older patients with benign prostatic hyperplasia.

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