Finasteride is a common medication used to treat hair loss and enlargement of the prostate gland.
However, new research shows this drug may also increase the risk of depression and suicidal thoughts.
Key Facts:
- Finasteride works by reducing levels of a hormone called DHT in the body. DHT contributes to hair loss and prostate enlargement.
- By lowering DHT, finasteride can effectively treat hair loss and prostate enlargement in men. It’s sold under brand names like Propecia and Proscar.
- However, DHT also plays a role in mood regulation. Lowering DHT may lead to increased risk of depression and even suicidal thoughts.
- Multiple studies show men taking finasteride have a significantly higher risk of developing depression compared to men not taking the drug.
- The effects can persist even after stopping finasteride, especially sexual side effects. A high proportion of men have sustained sexual problems after quitting the medication.
- Experts recommend informing patients of potential mental health risks before prescribing finasteride. Use caution in men with risk factors for depression.
How Finasteride Works: 5-alpha-reductase inhibitor
Finasteride treats hair loss and enlarged prostate by blocking an enzyme called 5-alpha-reductase.
This enzyme converts the hormone testosterone into a more potent form called dihydrotestosterone or DHT.
DHT contributes to hair loss and prostate enlargement.
By inhibiting 5-alpha-reductase, finasteride reduces levels of DHT in the body.
This provides relief of symptoms but also impacts other DHT-related processes.
Studies show finasteride can decrease DHT levels by up to 70% in some tissues.
This dramatic drop affects many parts of the body, including the brain.
The Role of DHT in Mood and Mental Health
Although best known for its role in hair growth and prostate issues, DHT has other important functions.
Research shows DHT helps regulate neurosteroids that control mood and behavior.
Neurosteroids like allopregnanolone act on receptors for neurotransmitters involved in depression and anxiety.
When DHT levels fall too low, it can reduce production of helpful neurosteroids.
Animal studies demonstrate depressed behavior in subjects with very low DHT.
Male rats with depleted DHT show behaviors indicating sadness, loss of interest, and hopelessness.
In humans, men with lower DHT and similar neurosteroids have higher rates of depression.
This suggests maintaining adequate DHT is important for mental health.
Studies Link Finasteride to Increased Depression
Multiple studies have now linked use of finasteride to increased risk of depression and suicidal thoughts.
A recent meta-analysis pooled data from several trials and found men taking finasteride had a significantly higher risk of depressive symptoms compared to men not taking the drug.
Another large analysis found suicidal thinking and behavior was more common in men using finasteride compared to non-users.
The effects persisted even after stopping the medication.
Men with a history of taking finasteride continued to have elevated depression and suicide risk.
Sexual Side Effects May Contribute to Mental Health Issues
In addition to depression, finasteride frequently causes sexual side effects like reduced libido and erectile dysfunction.
These effects are another potential contributor to mental health problems.
A high percentage of men who take finasteride develop persistent sexual dysfunction that continues even after quitting the medication.
Often these side effects fail to resolve over time.
Coping with ongoing sexual problems can take a major toll on mental health.
It may worsen depression, increase stress, and damage self-esteem.
Resolving these symptoms is important for overall well-being.
Who May Be Impacted from Depression on Finasteride
The mental health effects likely depend on individual factors like genetics, diet, lifestyle, and more.
Those already vulnerable to depression may see greater risks.
So far, studies have only evaluated finasteride in men.
But women may also be impacted, as DHT plays a role in the female brain too.
The effects in women need further research.
Likewise, implications in teens and older adults remain unknown, as only adult men have been included in trials so far.
Further research is needed on age-related risks.
Weighing the Benefits and Risks of Finasteride
For many men, the benefits of finasteride may outweigh the risk of depression.
However, patients should be informed of potential mental health side effects before starting the medication.
Doctors may recommend extra precautions in those already prone to depression or anxiety.
Sometimes reducing the finasteride dose can limit side effects. Men with concerning symptoms should speak to their doctor promptly.
In severe or persistent cases, stopping finasteride may be warranted.
If depression develops, seeking counseling or other mental health treatment is advised, even after quitting the drug.
The Bottom Line on Finasteride & Depression Risk
Finasteride treats common male health issues like hair loss and enlarged prostate.
However, reducing DHT may also increase the risk of depression and suicidal thoughts in some men.
Patients should discuss mental health risks with their doctor before taking finasteride.
Stay alert for any changes in mood, behavior, or sexual function.
Promptly report concerning symptoms so appropriate action can be taken.
With informed use and monitoring, finasteride remains an effective option for many men.
But being aware of potential psychological side effects is important for identifying problems early.
Maintaining mental health is too important to ignore.
References
- Study: Risk of depression associated with finasteride treatment
- Authors: Maurizio Pompili et al. (2021)
- Study: Finasteride induced depression: a prospective study
- Authors: Babak Rahimi-Ardabili et al. (2006)
