2017.04.04 04:08
The use of 5α-reductase inhibitors were not found to be associated with an increase in suicide in older men, a recent study found; however, the risk of self-harm and depression were significantly increased, primarily during the first 18 months after initiation of the medication. This population-based matched cohort study included 93,197 men aged ≥66 years who initiated a new prescription for a 5α-reductase inhibitor during the study period of 2003 through 2013. Main outcome was suicide; secondary outcomes were self-harm and depression. Among the findings:
Citation:
Welk B, McArthur E, Ordon M, Anderson KK, Hayward J, Dixon S. Association of suicidality and depression with 5α-reductase inhibitors. [Published online ahead of print March 20, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.0089.
Commentary:
5α-reductase inhibitors (5ARI) are recommended for treatment of benign prostatic hypertrophy (BPH) and lower urinary tract symptoms (LUTS) caused by BPH.1 5ARI work by inhibiting 5AR, which is responsible for the conversion of testosterone to dihydrotestosterone. The 2 5ARI’s, finasteride and dutasteride, decrease prostate volume, LUTS, future BPH-related complications, and the need for future prostate surgery.2 However, in 2011, the FDA received a postmarketing submissions raising a concern of self-harm and suicide potentially associated with finasteride. This occurrence is biologically feasible as 5ARI affects the production of a number of neuroactive peptides. Additionally, testosterone and dihydrotestosterone are involved in the body’s stress response, so an alteration in the conversion may affect response to stress. The current observational study supports that such a relationship may exist. Therefore, it may be wise to keep this study in mind when it comes to decision-making regarding 5ARI, especially in men who have a history of depression or who are currently experiencing an unusually high amount of stress. —Neil Skolnik, MD
This is an interesting, new observation.
5 alpha reductase inhibitors are finasteride and dutasteride.
The brand names of finasteride are Proscar and Propecia.
The brand name of dutasteride is Avodart.
Many elderly men with BPH including Donald Trump take these drugs.
I myself took it for some ten years and stopped it a couple of years ago.
This study is saying these drugs may make men depressed during the first 18 months,
and then OK thereafter.
Many elderly men suffer from depression to begin with so these drugs could make things
more difficult for them.
So Pablo Picasso meant this when he said,
"The older you get, the stronger the wind gets - and it's always in your face."