Brain, mind & behavior
- General
- Behavior & stress response
- Cognition, memory & speech
- Depression & suicidality
- Other psychiatric conditions
General
Magri ML, Gottardo MF, Zárate S, et al. Opposite effects of dihydrotestosterone and estradiol on apoptosis in the anterior pituitary gland from male rats. Endocrine. 2016. doi:10.1007/s12020-015-0719-2 • PubMed
Behavior & stress response
Animal studies
Bartolomé I, Llidó A, Darbra S, Pallarès M. Early postnatal allopregnanolone levels alteration and adult behavioral disruption in rats: Implication for drug abuse. Neurobiol Stress. 2019. doi:10.1016/j.ynstr.2019.100208 • PubMed
Dhillon HK, Singh T, Goel RK. Ferulic acid inhibits catamenial epilepsy through modulation of female hormones. Metab Brain Dis. 2022. doi:10.1007/s11011-022-01054-w • PubMed [Finasteride increased seizure susceptibility and depression-like characteristics]
Diviccaro S, Giatti S, Borgo F, et al. 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. Psychoneuroendocrinology. 2019. doi:10.1016/j.psyneuen.2018.09.021 • PubMed
Frau R, Pillolla G, Bini V, Tambaro S, Devoto P, Bortolato M. Inhibition of 5α-reductase attenuates behavioral effects of D1-, but not D2-like receptor agonists in C57BL/6 mice. Psychoneuroendocrinology. 2013. doi:10.1016/j.psyneuen.2012.07.014 • PubMed
Godar SC, Cadeddu R, Floris G, et al. The steroidogenesis inhibitor finasteride reduces the response to both stressful and rewarding stimuli. Biomolecules. 2019. doi:10.3390/biom9110749 • PubMed
Li L, Kang YX, Ji XM, et al. Finasteride inhibited brain dopaminergic system and open-field behaviors in adolescent male rats. CNS Neurosci Ther. 2018. doi:10.1111/cns.12781
Mann PE. Finasteride delays the onset of maternal behavior in primigravid rats. Physiol Behav. 2006. doi:10.1016/j.physbeh.2006.04.008 • PubMed
Maurice-Gélinas C, Deslauriers J, Monpays C, Sarret P, Grignon S. The 5α-reductase inhibitor finasteride increases suicide-related aggressive behaviors and blocks clozapine-induced beneficial effects in an animal model of schizophrenia. Physiol Behav. 2018. doi:10.1016/j.physbeh.2018.03.036 • PubMed
Soggiu A, Piras C, Greco V, et al. Exploring the neural mechanisms of finasteride: a proteomic analysis in the nucleus accumbens. Psychoneuroendocrinology. 2016. doi:10.1016/j.psyneuen.2016.10.001 • PubMed
Cognition & memory
Original investigation
Ganzer CA, Jacobs AR, Iqbal F. Persistent sexual, emotional, and cognitive impairment post-finasteride: a survey of men reporting symptoms. Am J Mens Health. 2015. doi:10.1177/1557988314538445 • PubMed
Cohort studies
Garcia-Argibay M, Hiyoshi A, Fall K, Montgomery S. Association of 5α-reductase inhibitors with dementia, depression, and suicide. JAMA Netw Open. 2022. doi:10.1001/jamanetworkopen.2022.48135 • PubMed
Welk B, McArthur E, Ordon M, Morrow SA, Hayward J, Dixon S. The risk of dementia with the use of 5 alpha reductase inhibitors. J Neurol Sci. 2017. doi:10.1016/j.jns.2017.05.064 • PubMed
Pharmacovigilance
[Preprint] Fusaroli M, Simonsen A, Borrie SA, et al. Identifying medications underlying communication atypicalities in psychotic and affective disorders: a pharmacovigilance study within the FDA Adverse Event Reporting System. medRxiv 2022. doi:10.1101/2022.09.05.22279609
This preprint found an elevated risk of ‘low productivity speech or thought’ linked to finasteride, in a non-neuropsychiatric population (see Supplement 2).
Review
Kim YJ, Tae BS, Bae JH. Cognitive function and urologic medications for lower urinary tract symptoms. Int Neurourol J. 2020. doi:10.5213/inj.2040082.041 • PubMed
Animal studies
Ahire A, Nair, KP, Shankaranarayana Rao BS, Srikumar BN. The potential involvement of cholinergic system in finasteride induced cognitive dysfunction. Psychoneuroendocrinology. 2021. doi:10.1016/j.psyneuen.2020.105066 • PubMed
Diviccaro S, Giatti S, Borgo F, et al. 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. Psychoneuroendocrinology. 2019. doi:10.1016/j.psyneuen.2018.09.021 • PubMed
Mendell AL, Creighton SD, Wilson HA, et al. Inhibition of 5α reductase impairs cognitive performance, alters dendritic morphology and increases Tau phosphorylation in the hippocampus of male 3xTg-AD mice. Neuroscience. 2020. doi:10.1016/j.neuroscience.2020.01.011 • PubMed
Römer B, Pfeiffer N, Lewicka S, et al. Finasteride treatment inhibits adult hippocampal neurogenesis in male mice. Pharmacopsychiatry. 2010. doi:10.1055/s-0030-1249095 • PubMed
Depression and suicidality
Clinical trials
Dušková M, Hill M, Hanuš M, Matoušková M, Stárka L. Finasteride treatment and neuroactive steroid formation. Prague Med Rep. 2009. Journal site • PubMed
Rahimi-Ardabili B, Pourandarjani R, Habibollahi P, Mualeki A. Finasteride induced depression: a prospective study. BMC Clin Pharmacol. 2006. doi:10.1186/1472-6904-6-7 • PubMed
Original investigations
Ganzer CA, Jacobs AR. Emotional consequences of finasteride: fool’s gold. Am J Mens Health. 2018. doi:10.1177/1557988316631624 • PubMed
Irwig MS. Depressive symptoms and suicidal thoughts among former users of finasteride with persistent sexual side effects. J Clin Psychiatry. 2012. doi:10.4088/JCP.12m07887 • PubMed
Melcangi RC, Caruso D, Abbiati 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. J Sex Med. 2013. doi:10.1111/jsm.12269 • PubMed
Surendran P, Stewart, ID, Au Yeung VPW, et al. Rare and common genetic determinants of metabolic individuality and their effects on human health. Nat Med. 2022. doi:10.1038/s41591-022-02046-0 • PubMed • PMC full text
Case series
Altomare G, Capella GL. Depression circumstantially related to the administration of finasteride for androgenetic alopecia. J Dermatol. 2002. doi:10.1111/j.1346-8138.2002.tb00200.x • PubMed
Irwig MS. Finasteride and suicide: a postmarketing case series. Dermatology. 2020. doi:10.1159/000505151 • PubMed
Cohort studies
Dyson TE, Cantrell MA, Lund BC. Lack of association between 5α-reductase inhibitors and depression. J Urol. 2020. doi:10.1097/JU.0000000000001079 • PubMed
Garcia-Argibay M, Hiyoshi A, Fall K, Montgomery S. Association of 5α-reductase inhibitors with dementia, depression, and suicide. JAMA Netw Open. 2022. doi:10.1001/jamanetworkopen.2022.48135 • PubMed
Hagberg KW, Divan HA, Nickel JC, Jick SS. Risk of incident antidepressant-treated depression associated with use of 5α-reductase inhibitors compared with use of α-blockers in men with benign prostatic hyperplasia: a population-based study using the Clinical Practice Research Datalink. Pharmacotherapy. 2017. doi:10.1002/phar.1925 | PubMed
Kim JA, Choi D, Choi S, Chang J, Park SM. The association of 5α-reductase inhibitor with suicidality. Psychosom Med. 2020. doi:10.1097/PSY.0000000000000784 • PubMed
Laanani M, Weill A, Jollant F, Zureik M, Dray-Spira R. Suicidal risk associated with finasteride versus dutasteride among men treated for benign prostatic hyperplasia: nationwide cohort study. Sci Rep. 2023. doi:10.1038/s41598-023-32356-3 • PubMed • PMC full text
Welk B, McArthur E, Ordon M, Anderson KK, Hayward J, Dixon S. Association of suicidality and depression with 5α-reductase inhibitors. JAMA Intern Med. 2017. doi:10.1001/jamainternmed.2017.0089 • PubMed • PMC full text
Pharmacovigilance
Ali AK, Heran BS, Etminan M. Persistent sexual dysfunction and suicidal ideation in young men treated with low-dose finasteride: a pharmacovigilance study. Pharmacotherapy. 2015. doi:10.1002/phar.1612 • PubMed
[Abstract] Campbell K, Velazquez O, Sullivan J, Lipshultz L. Finasteride-associated suicide and depression in men treated for hypogonadism and impotence. The Journal of Sexual Medicine. 2022;19(4):S4-S5. doi:10.1016/j.jsxm.2022.01.019
Nguyen DD, Marchese M, Cone EB, et al. Investigation of suicidality and psychological adverse events in patients treated with finasteride. JAMA Dermatol. 2020. doi:10.1001/jamadermatol.2020.3385 • PubMed
Meta-analyses
Deng T, Duan X, He Z, Zhao Z, Zeng G. Association between 5-alpha reductase inhibitor use and the risk of depression: a meta-analysis. Urol J. 2020. doi:10.22037/uj.v16i7.5866 • PubMed
Kim JH, Shim SR, Khandwala Y, Del Giudice F, Sorensen S, Chung BI. Risk of depression after 5 alpha reductase inhibitor medication: meta-analysis. World J Mens Health. 2020. doi:10.5534/wjmh.190046 • PubMed
Pompili M, Magistri C, Maddalena S, Mellini C, Persechino S, Baldessarini RJ. Risk of depression associated with finasteride treatment. J Clin Psychopharmacol. 2021. doi:10.1097/JCP.0000000000001379 • PubMed
These findings were updated in Baldessarini et al, 2021, found in ‘Research letters.’
Research letters
Baldessarini RJ, Pompili M. Further studies of effects of finasteride on mood and suicidal risk. J Clin Psychopharmacol. 2021. doi:10.1097/jcp.0000000000001485 • PubMed
This letter is an update to Pompili et al, 2021, found in ‘Meta-analyses.’
Brezis M. Neuropsychiatric reactions to finasteride: nocebo or true effect? J Basic Clin Pharma. 2023;14(1):220-222. Web • PDF
Römer B, Gass P. Finasteride-induced depression: new insights into possible pathomechanisms. J Cosmet Dermatol. 2010. doi:10.1111/j.1473-2165.2010.00533.x • PubMed • Erratum in: J Cosmet Dermatol. 2011.
Reviews
Al Saffar H, Xu J, O’Brien JS, Kelly BD, Murphy DG, Lawrentschuk N. US Food and Drug Administration warning regarding finasteride and suicidal ideation: What should urologists know? Eur Urol Open Sci. 2023. doi:10.1016/j.euros.2023.04.009 • PubMed • PMC full text
Bortnick EM, Simma-Chiang V, Kaplan SA. Long-term consequences of medical therapy for benign prostatic hyperplasia. Rev Urol. 2019. PubMed • PMC full text
Gur S, Kadowitz PJ, Hellstrom WJ. Effects of 5-alpha reductase inhibitors on erectile function, sexual desire and ejaculation. Expert Opin Drug Saf. 2013. doi:10.1517/14740338.2013.742885
Muderrisoglu AE, Becher KF, Madersbacher S, Michel MC. Cognitive and mood side effects of lower urinary tract medication. Expert Opin Drug Saf. 2019. doi:10.1080/14740338.2019.1652269 • PubMed
Saengmearnuparp T, Lojanapiwat B, Chattipakorn N, Chattipakorn S. The connection of 5-alpha reductase inhibitors to the development of depression. Biomed Pharmacother. 2021. doi:10.1016/j.biopha.2021.112100 • PubMed • Full text
Singh MK, Avram M. Persistent sexual dysfunction and depression in finasteride users for male pattern hair loss: a serious concern or red herring? J Clin Aesthet Dermatol. 2014. PubMed
Traish AM, Hassani J, Guay AT, Zitzmann M, Hansen ML. Adverse side effects of 5α-reductase inhibitors therapy: persistent diminished libido and erectile dysfunction and depression in a subset of patients. J Sex Med. 2011. doi:10.1111/j.1743-6109.2010.02157.x • PubMed
Traish AM, Mulgaonkar A, Giordano N. The dark side of 5α-reductase inhibitors’ therapy: sexual dysfunction, high Gleason grade prostate cancer and depression. Korean J Urol. 2014. doi:10.4111/kju.2014.55.6.367 • PubMed
Walton NL, Antonoudiou P, Maguire JL. Neurosteroid influence on affective tone. Neurosci Biobehav Rev. 2023. doi:10.1016/j.neubiorev.2023.105327 • PubMed
Editorials & commentaries
Schmutz JL. Dépression et idées suicidaires avec le finastéride [Depression and suicidal thoughts associated with finasteride]. Ann Dermatol Venereol. 2018. doi:10.1016/j.annder.2018.01.006 • PubMed
Thielke S. The risk of suicidality and depression from 5-α reductase inhibitors. JAMA Intern Med. 2017. doi:10.1001/jamainternmed.2017.0096 • PubMed
Trüeb RM, Gavazzoni Dias MFR, Dutra Rezende H. Suicidality and psychological adverse events in patients treated with finasteride. Skin Appendage Disord. 2021. doi:10.1159/000514365 • PubMed • PMC full text
Animal studies
Diviccaro S, Giatti S, Borgo F, et al. 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. Psychoneuroendocrinology. 2019. doi:10.1016/j.psyneuen.2018.09.021 • PubMed
Maurice-Gélinas C, Deslauriers J, Monpays C, Sarret P, Grignon S. The 5α-reductase inhibitor finasteride increases suicide-related aggressive behaviors and blocks clozapine-induced beneficial effects in an animal model of schizophrenia. Physiol Behav. 2018. doi:10.1016/j.physbeh.2018.03.036 • PubMed
Sasibhushana RB, Shankaranarayana Rao BS, Srikumar BN. Repeated finasteride administration induces depression-like behavior in adult male rats. Behav Brain Res. 2019. doi:10.1016/j.bbr.2019.03.006 • PubMed
Other psychiatric conditions
Harth W, Linse R. Body dysmorphic disorder and life-style drugs. Overview and case report with finasteride. Int J Clin Pharmacol Ther. 2001. doi:10.5414/cpp39284 • PubMed
Trüeb RM. Psychiatric comorbidity related to the therapy of male androgenetic alopecia independent of the 5-alpha reductase pathway. Skin Appendage Disord. 2022. doi:10.1159/000518750 • PubMed • PMC full text
Trüeb RM, Régnier A, Dutra Rezende H, Gavazzoni Dias MFR. Post-finasteride syndrome: an induced delusional disorder with the potential of a mass psychogenic illness? Skin Appendage Disord. 2019. doi:10.1159/000497362 • PubMed