Association of Suicidality and Depression With 5α-Reductase Inhibitors

    May 2017 in “JAMA Internal Medicine
    Blayne Welk, Eric McArthur, Michael Ordon, Kelly K. Anderson, Jade Hayward, Stephanie N. Dixon
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    TLDR Men over 66 taking medication for prostate enlargement have a higher risk of depression and self-harm, especially in the first 18 months of treatment.
    The study from May 1, 2017, involving 93,197 men aged 66 years or older in Ontario, Canada, found that while there was no significant increase in suicide risk associated with the use of 5α-reductase inhibitors (5ARIs) for prostatic enlargement, there was a significant increase in the risk of self-harm (HR 1.88) and incident depression (HR 1.94) during the first 18 months of treatment. After 18 months, the risk of depression remained elevated (HR 1.22), but the risk of self-harm was not significantly higher. The absolute increases in event rates were 17 per 100,000 patient-years for self-harm and 237 per 100,000 patient-years for depression. The study concluded that while the risks of self-harm and depression were higher among men taking 5ARIs, the benefits of the medication likely outweigh these risks for most patients, but discontinuation may be appropriate if psychiatric adverse effects are observed.
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