title: Depressive symptoms and suicidal thoughts among former users of finasteride with persistent sexual side effects.
abstract: OBJECTIVE
  Finasteride, a commonly prescribed medication for male pattern hair loss, has recently been associated with persistent sexual side effects. In addition, depression has recently been added to the product labeling of Propecia (finasteride 1 mg). Finasteride reduces the levels of several neuroactive steroids linked to sexual function and depression. This study assesses depressive symptoms and suicidal thoughts in former users of finasteride who developed persistent sexual side effects despite the discontinuation of finasteride.
  
  
  METHODS
  In 2010-2011, former users of finasteride (n = 61) with persistent sexual side effects for ≥ 3 months were administered standardized interviews that gathered demographic information, medical and psychiatric histories, and information on medication use, sexual function, and alcohol consumption. All former users were otherwise healthy men with no baseline sexual dysfunction, chronic medical conditions, current or past psychiatric conditions, or use of oral prescription medications before or during finasteride use. A control group of men (n = 29), recruited 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 (BDI-II); all subjects self-administered this questionnaire at the time of the interview or up to 10 months later.
  
  
  RESULTS
  Rates of depressive symptoms (BDI-II score ≥ 14) were significantly higher in the former finasteride users (75%; 46/61) as compared to the controls (10%; 3/29) (P < .0001). Moderate or severe depressive symptoms (BDI-II score ≥ 20) 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 (P < .0001).
  
  
  CONCLUSIONS
  Clinicians and potential users of finasteride should be aware of the potential risk of depressive symptoms and suicidal thoughts. The preliminary findings of this study warrant further research with controlled studies.
authors.affiliation: Division of Endocrinology, Medical Faculty Associates and George Washington University, 2150 Pennsylvania Ave NW, Ste 3-416, Washington, DC 20037, USA. mirwig@mfa.gwu.edu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Irwig
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000009:adverse effects*; D000328:Adult; D000505:Alopecia / Q000188:drug therapy*; D016022:Case-Control Studies; D003866:Depressive Disorder / Q000139:chemically induced* / Q000453:epidemiology*; D018120:Finasteride / Q000009:adverse effects*; D006801:Humans; D008297:Male; D060735:Pharmacovigilance; D015995:Prevalence; D020018:Sexual Dysfunctions, Psychological / Q000139:chemically induced* / Q000453:epidemiology*; D059020:Suicidal Ideation; D014481:United States / Q000453:epidemiology
chemical_list: D058891:5-alpha Reductase Inhibitors; D018120:Finasteride