Brain, mind & behavior

💊 indicates pharma ties / conflict of interest

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

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

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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.2022.48135PubMed

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

Cho Y, Bea S, Bae JH, Kim DH, Lee JH, Shin JY. Cognitive dysfunction following finasteride use: a disproportionality analysis of the global pharmacovigilance database. Expert Opin Drug Saf. 2023. doi:10.1080/14740338.2023.2294926 • PubMed

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. J Speech Lang Hear Res. 2023. doi:10.1044/2023_JSLHR-22-00739PubMed

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

Sasibhushana RB, Shankaranarayana Rao BS, Srikumar BN. Anxiety-, and depression-like behavior following short-term finasteride administration is associated with impaired synaptic plasticity and cognitive behavior in male rats. J Psychiatr Res. 2024. doi:10.1016/j.jpsychires.2024.04.029 • PubMed

Depression, suicidality and anxiety

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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.12m07887PubMed

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/s41591-022-02046-0PubMedPMC 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.2022.48135PubMed

Hagberg KW, Divan HA, Nickel JC 💊 [COIs], 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/s41598-023-32356-3PubMedPMC 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 • PubMedPMC full text

Pharmacovigilance & pharmacoepidemiology

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

Campbell K, Velazquez O, Sullivan J, Lipshultz L. Finasteride-associated suicide and depression in men treated for hypogonadism and impotence [Abstract]. 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

Pennap D, Mosholder AD, Ajao A, et al. Suicide and intentional self-harm among older men treated with 5-alpha reductase inhibitor or alpha-blockers for benign prostatic hyperplasia. Urology. 2024. doi:10.1016/j.urology.2024.06.013 • 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.’

Uleri A, Nicolas Cornu J, Gobbo A, et al. Association of 5α-reductase inhibitors with depression and suicide: a mini systematic review and meta-analysis. Eur Urol Focus. 2024. doi:10.1016/j.euf.2024.04.009 • PubMed

Nguyen DD, Bhojani N, Trinh QD. Re: Alessandro Uleri, Jean Nicolas Cornu, Andrea Gobbo, et al. Association of 5α-reductase Inhibitors with depression and suicide: a mini systematic review and meta-analysis. Original article in: Eur Urol Focus (doi:10.1016/j.euf.2024.04.009). Comment in: Eur Urol Focus. 2024. doi:10.1016/j.euf.2024.06.013 • PubMed

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 • PubMedErratum 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

Müderrisoglu 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

Uleri A, Nicolas Cornu J, Gobbo A, et al. Association of 5α-reductase inhibitors with depression and suicide: a mini systematic review and meta-analysis. Eur Urol Focus. 2024. doi:10.1016/j.euf.2024.04.009 • 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

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

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. Anxiety-, and depression-like behavior following short-term finasteride administration is associated with impaired synaptic plasticity and cognitive behavior in male rats. J Psychiatr Res. 2024. doi:10.1016/j.jpsychires.2024.04.029 • 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

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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

Neurology & neurophysiology

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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]

Giatti S, Cioffi L, Diviccaro S, Piazza R, Melcangi RC. Analysis of the finasteride treatment and its withdrawal in the rat hypothalamus and hippocampus at whole-transcriptome level. J Endocrinol Invest. 2024. doi:10.1007/s40618-024-02345-y • PubMed

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

Melo DF, Saceda-Corralo D, Tosti A 💊 [COIs], et al. Frontal edema due to mesotherapy for androgenetic alopecia: a case series. Dermatol Ther. 2022. doi:10.1111/dth.15247 • PubMed

Pugnaghi M, Monti G, Biagini G, Meletti S. Temporal lobe epilepsy exacerbation during pharmacological inhibition of endogenous neurosteroid synthesis. BMJ Case Rep. 2013. doi:10.1136/bcr-2012-008204 • PubMed • PMC full text

Sasibhushana RB, Shankaranarayana Rao BS, Srikumar BN. Anxiety-, and depression-like behavior following short-term finasteride administration is associated with impaired synaptic plasticity and cognitive behavior in male rats. J Psychiatr Res. 2024. doi:10.1016/j.jpsychires.2024.04.029 • PubMed