Millions of men suffer with an enlarged prostate gland (benign prostatatic hypertrophy or BPH). One of the most annoying symptoms is getting up frequently to pee during the night. It can be hard to fall asleep again. Doctors prescribe two types of drugs. There are alpha blockers like Tamsulosin (Flomax) silodosin (Rapaflo) and doxazosin (Cardura). They relax smooth muscles around the bladder. The 5-alpha reductase inhibitors such as Dutasteride (Avodart) and finasteride (Proscar) actually shrink the prostate. A reader shared a rarely mentioned side effect: dutasteride and depression.
Dutasteride and Depression | A Serious Side Effect:
Q. Shortly after I was diagnosed with prostate cancer, my urologist prescribed dutasteride (generic for Avodart) to shrink my enlarged prostate. He thinks that a smaller, more condensed treatment site might improve my outcome.
Within a week of starting dutasteride, I was engulfed by severe depression–a sense of hopelessness I had never experienced before. I became extremely irritable, lost interest in my usual activities and didn’t feel like pursuing any treatment options.
I’ve experienced depression before and always managed to work through those episodes. What I felt on this drug was nothing like what I had dealt with in the past.
Within days of stopping dutasteride, I was back to normal. Am I concerned about having cancer? Sure! But I don’t feel hopeless or overwhelmed as I did on the drug.
I read up on dutasteride, but I didn’t see severe depression as a possible side effect in clinical trials. Is there any research on this problem?
Is There Data Linking Duatasteride and Depression
A. Dutasteride (Avodart) and finasteride (Proscar) are prescribed for men with enlarged prostate glands that interfere with the flow of urine. You are correct that the clinical trial data don’t reveal depression as an adverse effect of these drugs.
This points up one of the great weaknesses of randomized controlled trials. They do not always reveal important adverse reactions. It can take years before some side effects are discovered.
Information collected after FDA approval, however, does show dutasteride and depression are a thing. Some men seem susceptible to this psychological side effect. One study confirms that men taking dutasteride or finasteride are more likely to report depression or self harm (JAMA Internal Medicine, May 1, 2017).
What The Researchers Found:
Investigators performed an epidemiological study on over 90,000 older men in Ontario, Canada. They were taking either finasteride or dutasteride. These men were matched with controls who were not taking 5-alpha reductase inhibitors (5ARI).
The authors report:
“…we did demonstrate a significantly increased risk of self-harm (for the initial 18 months after initiation of a 5ARI), and new diagnoses of depression (throughout follow-up) among men exposed to 5ARI medications…These significant differences were consistent among both the finasteride and dutasteride users.”
The researchers note that depression is:
“associated with reduced functioning and quality of life” and is a “risk factor for future self-harm and suicide.”
Some people might speculate that an enlarged prostate might predispose some men to depression all by itself. But finasteride is also prescribed for male pattern baldness. A study published in the Journal of Dermatology (Oct. 2002) reported a series of cases (14 men and 5 women) who
“…developed a mood disturbance (moderate to severe depression) during treatment with finasteride…”
Dutasteride and Depression | Why a Link?
The authors of another study on 5ARIs and depression (BMC Clinical Pharmacology, Oct. 7, 2006) offer a possible explanation. Finasteride and dutasteride block the conversion of testosterone to dihydrotestosterone (DHT). Many health professionals have assumed that DHT is unimportant at best and counterproductive at worst. It does lead to enlargement of the prostate and male pattern baldness.
DHT may be more important than previously realized. The scientists noted:
“A decline in serum DHT level occurs after finasteride administration. This may contribute to finasteride induced depression. Some studies have been shown that serum DHT level, which is in equilibrium with the brain, is inversely associated with depression.”
Dutasteride, Finasteride and Sex:
Other side effects of 5 ARIs include erectile dysfunction and low libido. Reduced penis size and diminished pleasure during orgasm have also been reported. Some men complain that these adverse reactions can persist even after the drugs are discontinued. You can read more about these distressing complications at this link.
People’s Pharmacy Perspective:
We recognize that both dutasteride and finasteride can be important drugs. We would like health professionals to mention both the psychological as well as the physical side effects associated with these medications. This is especially true if someone is susceptible to depression.
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