Finasteride induced depression: a prospective study

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

ABSTRACT 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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    • "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 · 4.05 Impact Factor
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    • "Negative side effects of drugs may also be explained by neurosteroid modulation. Notably, preliminary studies indicate that, as in the rodent, finasteride may increase depression in men as a result of the loss of allopregnanolone (eg, Altomare et al, 2002; Rahimi-Ardabili et al, 2006). This raises the possibility that lowered levels of the neurosteroid contribute to the reduced sexual desire reported for some patients. "
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    ABSTRACT: Although gonadal and adrenal steroids heavily impact sexual function at the level of the brain, the nervous system also produces its own steroids de novo that may regulate sexual behavior and reproduction. Current evidence points to important roles for neurosteroids in sexual and gender-typical behaviors, control of ovulation, and behaviors that strongly influence sexual interest and motivation like aggression, anxiety and depression. At the cellular level, neurosteroids act through stimulating rapid changes in excitability and direct activation of membrane receptors in neurons. Thus, unlike peripheral steroids, neurosteroids can have immediate and specific effects on select neuronal pathways to regulate sexual function.
    Journal of Andrology 07/2008; 29(5):524-33. DOI:10.2164/jandrol.108.005660 · 1.69 Impact Factor
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