Al Saffar Haidar, Xu Jennifer, O'Brien Jonathan S, Kelly Brian D, Murphy Declan G, Lawrentschuk Nathan
Department of Genitourinary Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
Urology Department, St. Vincent's Hospital, Fitzroy, Australia.
Eur Urol Open Sci. 2023 Apr 29;52:4-6. doi: 10.1016/j.euros.2023.04.009. eCollection 2023 Jun.
Finasteride competitively inhibits 5α-reductase (5-AR) isoenzymes, which blocks dihydrotestosterone (DHT) production, thereby reducing DHT. Finasteride is used in the management of benign prostatic hyperplasia (BPH) and androgenic alopecia. Amid patient reports of suicidal ideation (SI), the Post Finasteride Syndrome advocacy group has petitioned for either a stop to selling of the drug or advertisement of stronger warnings. The US Food and Drug Administration recently added SI to the adverse effects listed for finasteride. Here we provide a brief but comprehensive review of the literature on the psychological side effects of 5-AR inhibitors (5-ARIs) to provide an opinion to help in guiding treating urologists. Most of the current evidence, obtained from the literature on dermatology, suggests that 5-ARI users experience a higher rate of depressive symptoms. However, given the lack of comprehensive randomised studies, the causal link between finasteride and SI remains unclear. Urologists prescribing 5-ARIs should be aware of the recent addition of suicide and SI risk to the list of side effects. A mental health screen should be performed and appropriate resources provided to patients commencing treatment. Furthermore, a review should be arranged with the general practitioner to assess new-onset mental health or SI symptoms.
We provide recommendations for urologists who prescribe finasteride for the treatment of benign prostate enlargement. Urologists should be aware of the recent addition of suicidal ideation to the list of side effects for this drug. Finasteride prescription should be continued; however, we recommend a detailed medical history to screen for prior mental health and personality disorders, with discontinuation of the medication in patients with new onset of depression or suicidal symptoms. Close liaison with the patient's general practitioner is vital for management of depressive or suicidal symptoms.
非那雄胺竞争性抑制5α-还原酶（5-AR）同工酶，从而阻断二氢睾酮（DHT）的生成，进而降低DHT水平。非那雄胺用于治疗良性前列腺增生（BPH）和雄激素性脱发。在有患者报告出现自杀意念（SI）后，非那雄胺综合征倡导组织已请求停止该药物的销售或发布更强的警告。美国食品药品监督管理局最近将SI添加到非那雄胺的不良反应列表中。在此，我们对5-AR抑制剂（5-ARIs）心理副作用的文献进行简要而全面的综述，以提供意见帮助指导泌尿外科医生的治疗。目前的大多数证据来自皮肤科文献，表明使用5-ARI的患者出现抑郁症状的几率更高。然而，鉴于缺乏全面的随机研究，非那雄胺与SI之间的因果关系仍不明确。开具5-ARIs的泌尿外科医生应意识到自杀和SI风险最近已被添加到副作用列表中。应进行心理健康筛查，并为开始治疗的患者提供适当的资源。此外，应安排与全科医生会诊，以评估新发的心理健康或SI症状。
我们为开具非那雄胺治疗良性前列腺增生的泌尿外科医生提供建议。泌尿外科医生应意识到最近该药物的副作用列表中增加了自杀意念。应继续开具非那雄胺处方；然而，我们建议详细询问病史以筛查既往心理健康和人格障碍情况，对于出现新发抑郁或自杀症状的患者应停药。与患者的全科医生密切联络对于管理抑郁或自杀症状至关重要。
