From the Guidelines
Finasteride is not absolutely contraindicated for men with depression, but caution is warranted. Men with a history of depression should discuss this with their healthcare provider before starting finasteride, as the medication has been associated with increased risk of depression and suicidal ideation in some patients 1. The FDA has added warnings about these potential psychiatric side effects to finasteride's labeling. The mechanism may involve finasteride's effects on neurosteroid production in the brain, as it inhibits the enzyme 5-alpha reductase, which converts testosterone to dihydrotestosterone (DHT). This reduction in DHT and potential alterations in other hormone levels might affect mood regulation in susceptible individuals.
Some key points to consider when prescribing finasteride to men with depression include:
- Monitoring for worsening depression symptoms, mood changes, or suicidal thoughts, especially during the first few months of treatment 1
- Considering alternative treatments for men with severe or unstable depression, or those with a history of suicidal ideation 1
- Discussing the potential benefits and risks of finasteride with the patient, including the reduction in prostate cancer incidence and the possible increase in high-grade cancer cases 1
- Informing men about the incidence of sexual adverse effects, such as lowered libido, and the potential for these effects to be reversible 1
If a man with depression does take finasteride (typically prescribed at 1mg daily for hair loss or 5mg daily for prostate conditions), he should be closely monitored for any changes in mood or behavior. The benefits of finasteride in reducing benign prostatic hyperplasia (BPH) symptoms and preventing prostate cancer should be weighed against the potential risks, and alternative treatments should be considered if necessary 1.
From the Research
Finasteride and Depression
- Finasteride, a medication used to treat androgenetic alopecia and benign prostatic hyperplasia, has been linked to depressive symptoms in some studies 2, 3, 4, 5.
- A prospective study found that finasteride treatment increased depressive symptoms in men with androgenetic alopecia, as measured by the Beck Depression Inventory and Hospital Anxiety and Depression Scale 2.
- Another study found that former users of finasteride with persistent sexual side effects had higher rates of depressive symptoms and suicidal thoughts compared to a control group of men who had never used finasteride 4.
- A review of finasteride for hair loss noted that the medication can cause sexual side effects, including erectile dysfunction and decreased libido, which can contribute to depression and suicidal thoughts 3.
- A study on the emotional consequences of finasteride use found that nearly 50% of men surveyed reported clinically significant depression, and 34% experienced anxiety 5.
Risk Factors for Depression in Finasteride Users
- Preexisting psychiatric conditions, such as depression and anxiety, may increase the risk of depressive symptoms in finasteride users 4, 5.
- A family history of psychiatric conditions may also contribute to the risk of depressive symptoms in finasteride users 5.
- Personality traits, such as neuroticism, may influence emotional well-being in finasteride users, but more research is needed to fully understand this relationship 5.
Clinical Implications
- Clinicians should be aware of the potential risk of depressive symptoms and suicidal thoughts in finasteride users, particularly those with a history of psychiatric conditions or a family history of mental health disorders 3, 4, 5.
- Patients should be carefully screened for psychiatric history and counseled about the potential psychological consequences of finasteride use 5.
- The risk-benefit ratio of finasteride use should be carefully weighed in patients with a history of depression or other psychiatric conditions 5.