Department of Urology, Minimally Invasive Surgery center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Urol J. 2020 Aug 23;18(2):144-150. doi: 10.22037/uj.v16i7.5866.
To explore the association between 5α-reductase inhibitors (5ARIs) use and risk of depression based on published literature through a meta-analysis.
A comprehensive literature search was conducted by searching Pubmed, Embase, Cochrane Library, CBM, CNKI, and VIP databases up to June, 2019. Summarized risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to evaluate the strength of association between 5ARIs and depression. Subgroup analyses were performed according to population, 5ARI types, degree of depression, and publication date. Registered in PROSPERO under number CRD42018096147.
A total of 6 clinical studies with 265672 participants were included in our meta-analysis. The application of 5ARIs could significantly increase the risk of depression based on both pooled unadjusted (95% CI: 1.28-2.78, RR = 1.89, P = .001) and multivariable adjusted RRs (95% CI: 1.01-1.17, RR = 1.09, P = .03). In subgroup analyses, dutasteride was associated with depression significantly (95% CI: 1.37-1.70, RR = 1.53, P < .001), while finasteride was not. As to the degree of depression, 5ARIs mainly caused mild depression (95% CI: 1.91-2.33, RR = 2.11, P < .001), instead of moderate or severe depression.
We concluded that 5ARIs could potentially increase the risk of depression. Clinicians need to carefully consider the use of 5ARIs for benign prostatic hyperplasia and androgenic alopecia patients, especially those exhibiting risk factors for depression or those who have a previous history of depression. More studies with larger sample size and comprehensive study design are needed to further verify our outcomes.
通过荟萃分析，基于已发表的文献，探讨 5α-还原酶抑制剂（5ARIs）的使用与抑郁风险之间的关系。
通过检索 Pubmed、Embase、Cochrane Library、CBM、CNKI 和 VIP 数据库，对截至 2019 年 6 月的文献进行全面的文献检索。计算汇总的风险比（RR）及其 95%置信区间（CI），以评估 5ARIs 与抑郁之间的关联强度。根据人群、5ARI 类型、抑郁程度和发表日期进行亚组分析。在 PROSPERO 中注册，编号为 CRD42018096147。
本荟萃分析共纳入 6 项临床研究，共 265672 名参与者。基于汇总的未调整（95% CI：1.28-2.78，RR=1.89，P=0.001）和多变量调整后的 RR（95% CI：1.01-1.17，RR=1.09，P=0.03），5ARIs 的应用可显著增加抑郁的风险。在亚组分析中，度他雄胺与抑郁显著相关（95% CI：1.37-1.70，RR=1.53，P<0.001），而非那雄胺则不然。至于抑郁程度，5ARIs 主要导致轻度抑郁（95% CI：1.91-2.33，RR=2.11，P<0.001），而不是中度或重度抑郁。
我们的结论是，5ARIs 可能会增加抑郁的风险。临床医生在为良性前列腺增生和雄激素性脱发患者使用 5ARIs 时需要谨慎考虑，特别是那些有抑郁风险因素或有抑郁病史的患者。需要更多的大样本量和综合研究设计的研究来进一步验证我们的结果。
