5α-reductase inhibitors may increase risk for depression and self-harm

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The relatively small risks should not dissuade physicians from prescribing these medications in appropriate patients, the authors say.

5α-reductase inhibitors (5ARIs) are not associated with increased suicide risk in older men, but risks for self-harm and depression were increased during the first 18 months after initiation of treatment, according to an article published online by JAMA Internal Medicine .

The new population-based study compared psychiatric outcomes in more than 93,000 older men who started a new prescription for a 5ARI and a similar group not prescribed a 5ARI.

The authors report that the risk of self-harm was increased during the first 18 months after 5ARI initiation, but not after. Risk of new depression increased during those first 18 months and continued to be elevated, but to a lesser degree, during the remainder of the follow-up.

“The risk of suicide was not significantly elevated in men aged 66 years or older using 5ARIs for BPH [benign prostatic hyperplasia] , however the risks of self-harm and incident depression were significantly increased, primarily during the first 18 months after the initiation of either finasteride or dutasteride. The absolute increased risk of these two outcomes was low, and the potential benefits of 5ARIs in this population likely outweigh these risks for most patients,” the authors concluded.

 

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