5α-reductase inhibitors do not up risk of depression

Treatment with a 5α-reductase inhibitor does not appear to contribute to an elevated risk of depression, a study has found.

“Depressed mood and suicidality reported with 5α-reductase inhibitors (finasteride and dutasteride) during postmarketing surveillance resulted in the addition of depression risk to finasteride labeling,” according to the investigators.

A total of 53,848 male patients initiating 5α-reductase inhibitor therapy during fiscal year 2014 were identified using the National Veterans Health Administration administrative data. The two measures of antidepressant prescription and depression diagnosis were used to separately assess incident depression events.

Symmetry ratios (SR) were calculated as the ratio of patients with an incident depression event in the year following a 5α-reductase inhibitor treatment to the year preceding initiation. The investigators also conducted an identical exposure counterfactual analysis among veterans initiating α1-adrenergic receptor antagonists.

Incident antidepressant prescribing was noted in 2,563 patients after initiating 5α-reductase inhibitor and in 3,501 patients prior to 5α-reductase inhibitor treatment (SR, 0.84, 95 percent confidence interval [CI], 0.80–0.89). Findings were also similar for incident depression diagnosis (SR, 0.83, 95 percent CI, 0.79–0.86).

No positive association was found between 5α-reductase inhibitor and depression when stratified by age group, 5α-reductase inhibitor agent, antidepressant class, prior α1-adrenergic receptor antagonist exposure, and depression diagnosis type. Moreover, nearly identical results were seen in the α1-adrenergic receptor antagonist analysis (SR, 0.87, 95 percent CI, 0.84–0.90).

“Our findings support the hypothesis that depression is more likely attributable to underlying benign prostatic hyperplasia and associated lower urinary tract symptoms than 5α-reductase inhibitor exposure,” the investigators said.