Signal Detection Between 5-Alpha Reductase Inhibitors and the Risk of Suicidality and Depression: An International Pharmacovigilance Analysis

In this systematic review and meta-analysis, the authors found no statistically significant association between the use of 5α-reductase inhibitors and the risk of depression or suicide among over two million studied patients.

This study observed that short-term administration of finasteride in male Wistar rats induced anxiety-like and depression-like behaviors, impaired spatial learning and memory, and reduced synaptic plasticity in the hippocampus, with a trend of increased corticosterone levels noted.

In this study, dutasteride 0.5 mg was found to provide long-term efficacy and safety in treating androgenetic alopecia in Korean men, with 89.9% showing improvement and 93.9% experiencing prevention of disease progression over at least 5 years.

This study reviews the psychological side effects of finasteride, noting a potential association between 5-AR inhibitors and increased depressive symptoms, but emphasizes that the causal link to suicidal ideation remains unclear; the authors recommend mental health screenings and close monitoring for patients starting this medication.

This cohort study found no overall increased risk of suicidal behaviors with finasteride versus dutasteride in men aged 50 and older, but suggested potential risk for those with a history of mood disorders.

In this study, the authors reported that oral dutasteride at 0.5 mg/day showed a probable greater efficacy in treating male androgenetic alopecia compared to finasteride and minoxidil, but it may cause sexual dysfunction and neuropsychiatric side effects.

In this South Korean retrospective study, dutasteride improved hair growth more effectively than finasteride in men with androgenic alopecia, and had a similar or possibly lower rate of adverse events, suggesting it as a viable treatment option.

This review summarizes the association between 5-alpha reductase inhibitors and depression, discussing potential mechanisms such as neuroactive steroid alterations and neuroinflammation, but reports no new clinical results.

This meta-analysis reported that finasteride 1 mg/day significantly increased hair count in male androgenetic alopecia compared to placebo, but highlighted persistent sexual side effects and associated depression risk.

In this study, finasteride treatment was associated with an increased risk of depression, suicidal ideation, and persistent sexual dysfunction compared to those not treated with the drug.

This pharmacovigilance study found an increased association of suicidality and psychological adverse events with finasteride use, especially among younger patients using it for alopecia.

This meta-analysis concluded that 5α-reductase inhibitors may increase the risk of mild depression, particularly with dutasteride, in patients treated for benign prostatic hyperplasia and androgenic alopecia.

This study found that initiation of 5α-reductase inhibitors like finasteride is not associated with an increased risk of depression in veterans, suggesting depression may be linked to underlying health conditions instead.

This study found no significant increase in depression risk associated with taking five-alpha reductase inhibitors for benign prostatic hyperplasia or alopecia, although further studies are needed to confirm these findings.

This study found that patients with post-finasteride syndrome exhibited major depressive disorder, severe erectile dysfunction, and neuropathy, alongside altered neuroactive steroid levels in cerebrospinal fluid.

This study found that in Japanese male patients with androgenetic alopecia, dutasteride 0.5 mg daily over 52 weeks was associated with improvements in hair growth and appearance, with reported adverse events mostly mild.

This study found that low-dose finasteride use in young men was associated with higher reporting of persistent sexual dysfunction, with some cases linked to suicidal ideation.

This review found that 5α-reductase inhibitors are associated with slightly increased rates of sexual dysfunction, gynecomastia, and mood disorders, but the true significance and persistence of these effects remain unclear.

This study found that finasteride treatment in men with benign prostate hyperplasia significantly altered steroid hormone profiles and may contribute to depressive symptoms by affecting neuroactive steroid levels.

This review explores finasteride's effects on neuroactive steroid levels and their potential influence on disorders like depression and alcohol withdrawal but reports no new clinical findings.