From the Research
Patients with a history of depression or anxiety should be monitored closely when taking dutasteride (Avodart) due to a potential increased risk of suicidal thoughts, though this risk appears to be relatively low. While dutasteride is primarily prescribed for benign prostatic hyperplasia (BPH) and male pattern baldness, there have been reports of mood changes, depression, and in rare cases, suicidal ideation associated with its use. The mechanism may be related to dutasteride's effects on neurosteroids through 5-alpha reductase inhibition, which can influence mood regulation in the brain 1.
Some studies have suggested an association between 5α-reductase inhibitors, including dutasteride, and an increased risk of depression and suicidal ideation 2, 1. However, other studies have found no significant association between dutasteride and depression 3. A 2022 meta-analysis comparing the efficacy and safety of dutasteride and finasteride in patients with BPH found no significant difference in the risk of adverse reactions, including psychiatric effects, between the two medications 4.
Key points to consider:
- Patients with significant psychiatric history may benefit from more frequent follow-up appointments during the first few months of treatment.
- Healthcare providers should discuss the potential side effect of suicidal thoughts during the initial prescription conversation and weigh the benefits of dutasteride against these risks, especially in patients with pre-existing mental health conditions.
- Alternative treatments for BPH might be considered in patients with severe depression or recent suicidal ideation.
- The risk of suicidal thoughts associated with dutasteride appears to be relatively low, but patients should be advised to report any new or worsening psychological symptoms promptly to their healthcare provider.