Common medication used to treat men with an enlarged prostate increases risk of depression but not suicide

A common medication used to treat men with urinary symptoms due to an enlarged prostate does not lead to an increased risk of suicide according to a new study by researchers at the Institute for Clinical Evaluative Sciences (ICES).

There have been concerns raised by patients and regulatory agencies, including Health Canada, regarding serious psychiatric side effects that may be associated with 5-alpha reductase inhibitors (5ARIs).

In the study, published today in JAMA Internal Medicine, the researchers used routinely collected health data to compare the risks of suicide, self-harm and new onset depression among a large group of older men (93,197) using 5ARI’s (finasteride or dutasteride) for an enlarged prostate and those who were not using 5ARIs in Ontario from 2003 to 2013.

“Our study shows that 5-alpha reductase inhibitors do not lead to an increased risk of suicide. However, it is concerning that we found a small but significant increase in the risk of self-harm and depression,” says Blayne Welk, senior author of the study and adjunct scientist at ICES Western.

While the risks of self-harm and incident depression were significantly increased during the first 18 months after the initiation of finasteride or dutasteride, the absolute increased risk was low at 0.58 per cent which equals one extra case of depression for every 420 men treated with this medication for a year. The researchers stress that the potential benefits of 5ARIs in this population likely outweigh these risks for most patients.

“It is important that depression and self-harm are recognized as potential side effects of 5ARIs. However, the relatively small magnitude of these risks should not dissuade physicians from using these medications in appropriate patients. The outcomes from this study need to be assessed in younger men using finasteride for alopecia,” adds Welk, who is also an assistant professor at Western University’s Schulich School of Medicine & Dentistry.

This same type of medication is also used in lower doses for younger men to treat hair loss (alopecia) and similar concerns have been raised about psychiatric side effects in this age group.

The researchers add that in patients presenting with thoughts or evidence of self-harm or with a new diagnosis of depression, the continued use of this medication should be re-evaluated by their physician.

“The risk of suicidality and depression from 5-alpha reductase inhibitors,” was published today in JAMA Internal Medicine.

Author block: Blayne Welk, Eric McArthur, Michael Ordon, Kelly K. Anderson, Jade Hayward and Stephanie Dixon.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

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