Do Medications for Benign Prostate Syndrome Affect Mood or Cognition?

February 2019 in “ Der Urologe ”

Klaus Becher, Stephan Madersbacher, Martin C. Michel

5α-reductase inhibitors dutasteride finasteride muscarinic antagonists tamsulosin α1-adrenoceptor antagonists Propecia Avodart Flomax

From the encyclopedia

Dutasteride →

Heavy duty finasteride that comes with higher risks

Finasteride →

Frontline, gold standard treatment for combatting androgenic alopecia

tamsulosin →

Studysummary This review discusses the risk of central nervous side effects, such as dementia and depression, from drugs used to treat lower urinary symptoms related to benign prostatic hyperplasia, and highlights inconsistent evidence across different medications.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

The document examined the central nervous side effects of medications for benign prostatic syndrome (BPS), highlighting cognitive impairments and depressive symptoms. It found that muscarinic antagonists were associated with cognitive impairments, though the frequency varied. Depressive symptoms were consistently linked to 5α-reductase inhibitors like dutasteride and finasteride, with a plausible mechanism. A single study noted a moderate increase in dementia diagnoses with tamsulosin, but not with other α1-adrenoceptor antagonists, possibly due to selection bias. The document recommended that physicians monitor for these side effects during BPS treatment.

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Research cited in this study

7 / 7 results

Treatment of Male Rats with Finasteride, an Inhibitor of 5alpha-Reductase Enzyme, Induces Long-Lasting Effects on Depressive-Like Behavior, Hippocampal Neurogenesis, Neuroinflammation, and Gut Microbiota Composition

research Treatment of Male Rats with Finasteride, an Inhibitor of 5alpha-Reductase Enzyme, Induces Long-Lasting Effects on Depressive-Like Behavior, Hippocampal Neurogenesis, Neuroinflammation, and Gut Microbiota Composition

37 citations , September 2018 in “Psychoneuroendocrinology”

This study found that finasteride treatment in male rats led to enduring effects on depressive-like behavior, hippocampal neurogenesis and neuroinflammation, and gut microbiota composition after withdrawal.

research The Risk of Dementia with the Use of 5 Alpha Reductase Inhibitors

18 citations , June 2017 in “Journal of the neurological sciences”

In this study, the use of 5 alpha reductase inhibitors was associated with an increased risk of dementia during the first two years of treatment, but the risk was not significant with longer exposure.

research Investigation of the Plausibility of 5-Alpha-Reductase Inhibitor Syndrome

33 citations , January 2016 in “Skin appendage disorders”

This review examines medical literature on postfinasteride syndrome and reports no new results; the authors call for more controlled studies on permanent sexual dysfunction and mood changes linked to 5-alpha-reductase inhibitors.

research Effects of Subchronic Finasteride Treatment and Withdrawal on Neuroactive Steroid Levels and Their Receptors in the Male Rat Brain

33 citations , December 2015 in “Neuroendocrinology”

This study found that subchronic finasteride treatment in male rats altered neuroactive steroid levels and steroid receptor expression in the brain, with some changes persisting after drug withdrawal.

research Appropriateness of Oral Drugs for Long-Term Treatment of Lower Urinary Tract Symptoms in Older Persons: Results of a Systematic Literature Review and International Consensus Validation Process (LUTS-FORTA 2014)

111 citations , June 2015 in “Age and Ageing”

This study classified dutasteride, fesoterodine, and finasteride as beneficial for older or frail elderly patients, while suggesting caution or avoidance of α-blockers and antimuscarinics in this group.

Patients Treated for Male Pattern Hair Loss with Finasteride Show Altered Levels of Neuroactive Steroids in Cerebrospinal Fluid and Plasma After Discontinuation

research Patients Treated for Male Pattern Hair Loss with Finasteride Show Altered Levels of Neuroactive Steroids in Cerebrospinal Fluid and Plasma After Discontinuation

61 citations , April 2014 in “The Journal of Steroid Biochemistry and Molecular Biology”

This study reports that men with androgenic alopecia experience altered neuroactive steroid levels associated with persistent depression symptoms even after stopping finasteride treatment.

research Side Effects of 5-Alpha Reductase Inhibitors: A Comprehensive Review

35 citations , April 2013 in “Sexual medicine reviews”

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.