Finasteride's Effects on Mood
Yes, finasteride can affect mood, with approximately 0.5-0.6% of patients developing depression and anxiety, particularly those taking it for androgenetic alopecia. 1
Mood-Related Side Effects of Finasteride
- Finasteride has been associated with mood disturbances, including depression and anxiety, though these effects occur in a relatively small percentage of patients 2, 1
- In a large population-based case-control study, patients taking finasteride 1mg daily for androgenetic alopecia showed higher rates of anxiety (0.6% vs 0.4% in controls) and depression (0.5% vs 0.4% in controls) 1
- Multivariate analysis confirmed finasteride as a risk factor for both anxiety (OR 1.449) and depression (OR 1.003) in patients with androgenetic alopecia 1
- Interestingly, patients taking higher doses (5mg) for benign prostatic hyperplasia did not show significantly increased rates of psychiatric disorders compared to controls 1
Mechanism of Mood Effects
- Finasteride inhibits 5α-reductase enzyme, which is responsible for converting hormones like testosterone and progesterone into their 5α-reduced derivatives 3
- These 5α-reduced neurosteroids (particularly allopregnanolone) have natural anxiolytic and antidepressant properties in the brain 3
- Even low-dose finasteride (1mg/day) has been shown to decrease levels of these neuroactive steroids, which may contribute to mood disturbances 3
- Animal studies have demonstrated that short-term finasteride administration can induce anxiety-like and depression-like behaviors in rats, associated with impaired synaptic plasticity and cognitive function 4
Clinical Presentation and Time Course
- Mood disturbances typically develop after 9-19 weeks of treatment with finasteride 5
- Symptoms can include moderate to severe depression that significantly impairs social relationships, sleep, and eating behavior 5
- In some cases, depression is accompanied by marked anxiety 5
- In a prospective study, finasteride treatment significantly increased Beck Depression Inventory scores and Hospital Anxiety and Depression Scale depression scores 2
Resolution of Symptoms
- Mood symptoms typically resolve promptly after discontinuation of finasteride 5
- However, some case reports suggest that symptoms may persist in certain individuals even after stopping the medication 4
- In a small case series, reintroduction of finasteride in patients who had previously experienced depression led to relapse of depressive symptoms within 2 weeks 5
Risk Factors and Monitoring
- Patients with a history of depression or anxiety may be at higher risk for developing mood-related side effects 2
- Finasteride should be prescribed cautiously for patients with high risk of depression 2
- Regular monitoring for mood changes is advisable, particularly during the first 4-5 months of treatment 5
Other Common Side Effects for Context
- Sexual side effects are more common than mood disturbances, with erectile dysfunction occurring in approximately 4.7% of patients during the first 6 months 6
- Decreased libido is reported in about 3% of patients initially, decreasing to 0.3% by 19-24 months 6
- Ejaculation disorders occur in approximately 1.4% of patients initially 6
- Overall discontinuation rates due to all adverse events are approximately 6-7% 6
Clinical Implications
- When prescribing finasteride, patients should be informed about the potential for mood changes, though the absolute risk is relatively small 1
- For patients who develop significant depression or anxiety while on finasteride, discontinuation of the medication should be considered 5
- The risk-benefit assessment should weigh the benefits of finasteride against potential side effects, including mood disturbances 6