Finasteride induced depression: a prospective study. BMC Clin Pharmacol 2006, 6:7

Clinical Pharmacy Laboratory, Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
BMC Clinical Pharmacology (Impact Factor: 1.36). 10/2006; 6(1):7. DOI: 10.1186/1472-6904-6-7
Source: PubMed


Finasteride is a competitive inhibitor of 5 alpha-reductase enzyme, and is used for treatment of benign prostatic hyperplasia and androgenetic alopecia. Animal studies have shown that finasteride might induce behavioral changes. Additionally, some cases of finasteride-induced depression have been reported in humans. The purpose of this study was to examine whether depressive symptoms or anxiety might be induced by finasteride administration.
One hundred and twenty eight men with androgenetic alopecia, who were prescribed finasteride (1 mg/day) were enrolled in this study. Information on depressed mood and anxiety was obtained by Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS). Participants completed BDI and HADS questionnaires before beginning the treatment and also two months after it.
Mean age of the subjects was 25.8(+/- 4.4) years. At baseline, mean BDI and HADS depression scores were 12.11(+/- 7.50) and 4.04(+/- 2.51), respectively. Finasteride treatment increased both BDI (p < 0.001) and HADS depression scores significantly (p = 0.005). HADS anxiety scores were increased, but the difference was not significant (p = 0.061).
This preliminary study suggests that finasteride might induce depressive symptoms; therefore this medication should be prescribed cautiously for patients with high risk of depression. It seems that further studies would be necessary to determine behavioral effects of this medication in higher doses and in more susceptible patients.

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    • "Increased depressive symptoms are thought to be linked to finasteride treatment [97]. A statistically significant correlation was observed between use of finasteride and depressive symptoms [98]. Persistent side effects have been noted even after discontinuation of finasteride treatment [76] from 3 months to 11 years, suggesting that the adverse effects of finasteride may be permanent [97]. "
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    ABSTRACT: With aging, abnormal benign growth of the prostate results in benign prostate hyperplasia (BPH) with concomitant lower urinary tract symptoms (LUTS). Because the prostate is an androgen target tissue, and transforms testosterone into 5α-dihydrotestosterone (5α-DHT), a potent androgen, via 5α-reductase (5α-R) activity, inhibiting this key metabolic reaction was identified as a target for drug development to treat symptoms of BPH. Two drugs, namely finasteride and dutasteride were developed as specific 5α-reductase inhibitors (5α-RIs) and were approved by the U.S. Food and Drug Administration for the treatment of BPH symptoms. These agents have proven useful in the reducing urinary retention and minimizing surgical intervention in patients with BPH symptoms and considerable literature exists describing the benefits of these agents. In this review we highlight the adverse side effects of 5α-RIs on sexual function, high grade prostate cancer incidence, central nervous system function and on depression. 5α-Rs isoforms (types 1-3) are widely distributed in many tissues including the central nervous system and inhibition of these enzymes results in blockade of synthesis of several key hormones and neuro-active steroids leading to a host of adverse effects, including loss of or reduced libido, erectile dysfunction, orgasmic dysfunction, increased high Gleason grade prostate cancer, observed heart failure and cardiovascular events in clinical trials, and depression. Considerable evidence exists from preclinical and clinical studies, which point to significant and serious adverse effects of 5α-RIs, finasteride and dutasteride, on sexual health, vascular health, psychological health and the overall quality of life. Physicians need to be aware of such potential adverse effects and communicate such information to their patients prior to commencing 5α-RIs therapy.
    Korean journal of urology 06/2014; 55(6):367-379. DOI:10.4111/kju.2014.55.6.367
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    • "Very important, observations performed in a subset of patients for male pattern hair loss seem to indicate that persistent sexual side effects (e.g., low libido, erectile dysfunction , decreased arousal and difficulty in reaching orgasm) have been reported even after discontinuation of the treatment [8] [9]. Patients also developed depression during finasteride treatment [10] [11] that still persisted despite treatment withdrawal [12]. Depression after finasteride treatment might be due to impairment in the levels of neuroactive steroids. "
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    ABSTRACT: Observations performed in a subset of patients treated for male pattern hair loss seem to indicate that persistent sexual side effects as well as anxious/depressive symptomatology were reported even after discontinuation of finasteride treatment. Due to the capability of finasteride to block the metabolism of progesterone (PROG) and/or testosterone (T) we have evaluated, by liquid chromatography-tandem mass spectrometry, the levels of several neuroactive steroids in paired plasma and cerebrospinal fluid (CSF) samples obtained from post-finasteride patients and in healthy controls. At the examination, post-finasteride patients referred muscular stiffness, cramps, tremors and chronic fatigue in the absence of clinical evidence of any muscular disorder or strength reduction. Severity of the anxious/depressive symptoms were quite variable in their frequency, overall all the subjects had a fairly complex and constant neuropsychiatric pattern. Assessment of neuroactive steroid levels in CSF show a decrease of PROG and its metabolites, dihydroprogesterone (DHP) and tetrahydroprogesterone (THP), associated to an increase of its precursor pregnenolone (PREG). Altered levels were also observed for T and its metabolites. Thus, a significant decrease of dihydrotestosterone (DHT) associated to an increase of T as well as of 3α-diol was detected. Changes in neuroactive steroid levels also occurred in plasma. An increase of PREG, T, 3α-diol, 3β-diol and 17β-estradiol was associated to decreased levels of DHP and THP. The present observations show that altered levels of neuroactive steroids, associated to depression symptoms, are present in androgenic alopecia patients even after discontinuation of the finasteride treatment.
    The Journal of steroid biochemistry and molecular biology 04/2014; 146. DOI:10.1016/j.jsbmb.2014.03.012 · 3.63 Impact Factor
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    • "In addition to physical side effects, animal studies have also described behavioral changes with the use of finasteride, and case reports of finasteride-induced depression have also been reported in humans. This was formally evaluated by Rahimi-Ardabilli, in which 128 men with androgenic alopecia were prescribed 1 mg finasteride daily.29 Study subjects completed both the Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS) before the start of treatment and after two months of use. "
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    ABSTRACT: Benign prostatic hyperplasia (BPH) is a complex and progressive disease common in aging men. While associated with bothersome lower urinary tract symptoms, it may also result in additional serious complications such as refractory hematuria, acute urinary retention, and BPH-related surgery. Medical therapy has been offered as an approach to halt this progression and perhaps reverse the pathophysiology of BPH. While alpha-blockers provide rapid relief in the form of improved flow rate, their effects may not reduce the overall risk of BPH-related complications. 5alpha-reductase inhibitors were therefore introduced to affect the underlying disease process by inhibiting the enzyme which converts testosterone to dihydrotesterone, the primary androgen involved in normal and abnormal prostate growth. Through this inhibition, prostate size is decreased, thereby reducing the risk of acute urinary retention and BPH-related surgery while providing symptom control. These effects are most pronounced in men with enlarged prostates (>25 mL) who are at the greatest risk of disease progression. This article reviews the literature for finasteride used in the treatment of BPH and provides evidence for its efficacy, safety and tolerability, applicability for combination therapy, and considerations of its effects on prostate cancer risk.
    Therapeutics and Clinical Risk Management 07/2009; 5(3):535-45. · 1.47 Impact Factor
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