Suicidality, depression, anxiety higher in younger patients on finasteride for alopecia

Significant suicidality and adverse psychological events were reported in subjects who used finasteride to treat alopecia, according to a study published in JAMA Dermatology.

“Concerns have emerged about the adverse effects of finasteride, a drug indicated for the management of both male-pattern baldness (androgenetic alopecia) and benign prostatic hyperplasia,” David-Dan Nguyen, MPH, and colleagues wrote.

Finasteride, a 5-alpha-reductase inhibitor, has been linked to depression and anxiety, and reports of suicidality and psychological adverse events have led to the identification of post-finasteride syndrome and the creation of the Post-Finasteride Syndrome Foundation.

A pharmacovigilance case-noncase study identified 3,282 adverse events in finasteride users based on VigiBase, the WHO’s global database of case safety reports.

Suicidality, defined as suicidal ideation, attempted suicide and completed suicide, was reported in 356 cases (reporting OR 1.63; 95% CI, 1.46-1.81), and other adverse psychological events were reported in 2,926 cases (reporting OR 4.33; 95% CI, 4.17-4.49).

The majority of these were reported in individuals between 18 and 44 years of age, those using finasteride for alopecia (70.3%) and those living in the Americas (83.3%).

“These findings could raise concern that younger men with alopecia may be especially at risk for suicidality compared to the general population,” the authors wrote. “Suicidality and psychological adverse events associated with finasteride use by young patients undergoing treatment for alopecia and potential biases confounding this association merit further investigation.”