Depression finasteride

B. Finasteride is a 5a-reductase inhibitor, which essentially makes dihydrotestosterone unavailable to the prostate but does not reduce serum testosterone levels. The decreased prostatic levels of dihydrotestosterone frequently result in a size regression of the prostate, while the relatively normal testosterone levels minimize a depressed libido. Flutamide and spironolactone exhibit antiandrogen effects by competing for the androgen receptor ketoconazole inhibits testosterone synthesis and stanozolol is an oral anabolic androgen preparation. 

Finasteride, a commonly prescribed medication for male pattern hair loss, has been associated with persistent sexual side effects. In addition, depression has also been added when finasteride 1 mg is used. The drug reduces the levels of several neuroactive steroids linked to sexual function and depression. The current study assessed depressive symptoms and suicidal thoughts in former users of finasteride who developed persistent sexual side effects despite the discontinuation of the medication. 

Former users of finasteride (n=61) with persistent sexual side effects for over 3 months were administered standardised interviews that gathered demographic information, medical and psychiatric histories and information on medication use, sexual function, and alcohol consumption [24. All former users were otherwise healthy men not suffering from any of the pre-said conditions or users of oral prescription medications before or during finasteride use. A control group of 29 men, selected from the community, had male pattern hair loss but had never used finasteride and denied any history of psychiatric conditions or use of psychiatric medications. The primary outcomes were the prevalence of depressive symptoms and the prevalence of suicidal thoughts as determined by the Beck Depression Inventory II all subjects self-administered the questionnaire at tire time of the interview or up to 10 months later. 

Rates of depressive symptoms were significantly higher in the former finasteride users (75%, 46/61) as compared to the controls (10%, 3/29). Moderate or severe depressive symptoms were present in 64% (39/61) of the finasteride group and 0% of the controls. Suicidal thoughts were present in 44% (27/61) of the former finasteride users and in 3% (1/29) of the controls. 

Further observations performed in a subset of subjects treated with finasteride for male pattern hair loss seems, also, to indicate that sexual dysfunction as well as anxious/depressive symptomatology may occur at the end of the treatment and continue after discontinuation [26. A possible hypothesis to explain the depression symptoms after finasteride treatment might be impairment in the levels of neuroactive steroids. Therefore, neuroactive steroid levels were evaluated in paired plasma and cerebrospinal fluid samples obtained from male patients who received finasteride for the treatment of androgenic alopecia and who, after drug discontinuation, still show long-term sexual side effects as well as anxious/depressive symptomatology. 

Neuroactive steroid levels in plasma and cerebrospinal fluid of post-finasteride were measured in three patients and healthy controls. At the examination, the three post-finasteride patients reported muscular stiffness, cramps, tremors and chronic fatigue in the absence of clinical evidence on any muscular disorder or strength reduction. Severity and frequency of the anxious/depressive symptoms were quite variable overall, all the subjects had a fairly complex and constant neuropsychiatric pattern. Assessment of neuroactive steroid levels in patients showed some interindividual differences. Flowever, the most important finding was the comparison of their neuroactive steroid levels with those of healthy controls. Indeed, decreased levels of tetrahydroprogesterone, isopregnanolone and 17-beta-oestradiol were reported in cerebrospinal fluid of post-finasteride patients. Moreover, decreased levels of hydroprogesterone and increased levels of 5-alpha-androstane-3-alpha, 17-beta-diol and 17-beta-oestradiol were... 

Irwig MS. Depressive symptoms and suicidal thoughts among former users of finasteride with persistent sexual side effects. ] Chn Psych 2012 73(9) 1220-3. 

Melcangi RC, Caruso D, Abbiati F, Giatti S, Calabrese D, Piazza F, et al. Neuroactive steroid levels are modified in cerebrospinal fluid and plasma of post-finasteride patients showing persistent sexual side effects and anxious/depressive symptomatology. ] Sex Med 2013 10(10) ... 

Psychiatric Finasteride has recently been associated with persistent sexual side effects. In addition, depression has recently been added to tiie product labelling as an adverse effect. This is because finasteride reduces the levels of several neuroactive steroids linked to sexual fxmction and depression. In 2010-2011, former users of finasteride (n = 61) with persistent sexual side effects for >3 months were revised and psychologically evaluated and compared to a healthy group of men (n = 29) recruited from the community dwelling [99 ]. The primary outcomes were the prevalence of depressive symptoms and the prevalence of suicidal thoughts as determined by the Beck depression inventory II (BDI-II). The results of this study revealed that rates of depressive symptoms (BDI-II score >14) were significantly higher in the former finasteride users (75% 46/61) as compared to that in the controls (10% 3/29)... 

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