Citation

Pompili M, Magistri C, Maddalena S, Mellini C, Persechino S, Baldessarini RJ. J. Clin. Psychopharmacol. 2021; 41(3): 304-309.

Copyright

(Copyright © 2021, Lippincott Williams and Wilkins)

DOI

10.1097/JCP.0000000000001379

PMID

33814544

Abstract

BACKGROUND: Finasteride is one of several inhibitors of the 5α-reductase that converts testosterone to dihydrotestosterone used to treat hair loss and benign prostatic enlargement. Emerging clinical observations indicate that such treatment may be associated with depression, anxiety, and possibly increased suicidal risks, in addition to sexual dysfunction, even after its discontinuation.
METHODS: We carried out a systematic review of reports pertaining to association of finasteride treatment with clinical depression or other adverse psychiatric effects. We analyzed reported risks of depression by pooling of rates and by meta-analysis of comparisons of subjects treated with finasteride or not.
FINDINGS: Crude pooled rates of depressive symptoms with versus without finasteride were 3.33% (confidence interval, 3.22%-3.44%) versus 2.54% (2.44%-2.64%); random-effects meta-analysis yielded an odds ratio of 2.14 (1.40-3.27) (both P < 0.0001). In addition, risk of suicidal ideation or behavior was greater with versus without finasteride (21.2% [21.0%-21.5%] vs 14.0% [13.8%-14.2%], P < 0.0001), and risk of sustained sexual dysfunction was high (60.1% [37.3%-82.9%]).
CONCLUSIONS: The findings support a growing impression that finasteride is associated with adverse psychiatric effects that can persist in association with sexual dysfunction after discontinuing finasteride treatment.

Language: en

Keywords

Humans; Male; Depression; Suicidal Ideation; Alopecia; Finasteride; Prostatic Hyperplasia; 5-alpha Reductase Inhibitors; Sexual Dysfunction, Physiological