From the Guidelines
Finasteride use has been associated with a higher risk of depression, and patients should be closely monitored for mental health changes while using this medication, especially if they have a history of depression or other mood disorders. When considering the management of alopecia areata, it's crucial to weigh the potential psychological effects of the disease against the risks of treatments, as noted in the British Association of Dermatologists' guidelines from 2012 1. The guidelines emphasize that alopecia areata has no direct impact on general health, but its psychological effects can be significant, leading to higher levels of anxiety and a greater risk of depression. This is particularly relevant when considering the use of finasteride, which has been linked to depression in some users due to its mechanism of blocking the conversion of testosterone to dihydrotestosterone (DHT), potentially affecting neurosteroid production in the brain that regulates mood.
- Key considerations for patients using finasteride include:
- The potential for depression symptoms, which may occur in approximately 1-10% of users
- The importance of not stopping finasteride abruptly if depression symptoms occur, but instead consulting a healthcare provider
- Possible adjustments to the treatment plan, such as reducing the finasteride dosage or switching to topical finasteride, which has less systemic absorption
- Close monitoring of mental health, especially in patients with a history of depression or mood disorders In contrast, minoxidil, which stimulates hair follicles directly, has not been strongly linked to depression. Therefore, the decision to use finasteride should be made with caution, considering the individual's psychological well-being and potential risk factors for depression, as highlighted by the guidelines 1.
From the FDA Drug Label
- depression
- sexual dysfunction that continued after discontinuation of treatment, including erectile dysfunction, decreased libido and ejaculation disorders (e. g. reduced ejaculate volume). The finasteride drug label mentions depression as an adverse event reported in postmarketing experience 2.
- Depression is listed as an event with unknown causal relationship to finasteride exposure.
- The label does not provide information on the frequency or relationship of depression to finasteride and minoxidil use.
- Minoxidil is not mentioned in the provided drug label.
From the Research
Finasteride and Minoxidil for Hair Loss
- Finasteride and minoxidil are two common treatments for androgenetic alopecia, with finasteride being available in both oral and topical forms 3, 4, 5.
- Topical finasteride has been shown to be effective in reducing hair loss and promoting hair growth, with similar efficacy to oral finasteride in some studies 3, 5.
- Minoxidil is also an effective treatment for androgenetic alopecia, and can be used in combination with finasteride for enhanced efficacy 4, 6, 7.
Depression as a Side Effect
- There is no direct evidence in the provided studies to suggest that finasteride or minoxidil cause depression as a side effect.
- However, oral finasteride has been associated with systemic side effects, including sexual dysfunction, which may have an impact on mental health 5.
- Topical finasteride is considered to have a lower risk of systemic side effects compared to oral finasteride, with most side effects being localized to the application site 5.
Comparison of Treatments
- A retrospective cohort study compared the effects of topical finasteride, oral finasteride, and topical minoxidil in postmenopausal women with pattern hair loss, and found that oral finasteride was ranked as the most effective treatment, although no significant statistical differences were found between the treatments 6.
- A systematic review and meta-analysis found that minoxidil, finasteride, and low-level laser light therapy were all effective for promoting hair growth in men with androgenetic alopecia, and that minoxidil was effective in women with androgenetic alopecia 7.