{"id":3740,"date":"2017-03-20T00:00:00","date_gmt":"2017-03-20T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/association-of-suicidality-and-depression-with-5alpha-reductase-inhibitors\/"},"modified":"2023-06-14T19:31:04","modified_gmt":"2023-06-14T23:31:04","slug":"association-of-suicidality-and-depression-with-5alpha-reductase-inhibitors","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/association-of-suicidality-and-depression-with-5alpha-reductase-inhibitors\/","title":{"rendered":"Association of suicidality and depression with 5alpha-reductase inhibitors"},"content":{"rendered":"<p><strong>Importance<\/strong> &#x2014; There have been concerns raised by patients and regulatory agencies regarding serious psychiatric side effects associated with 5-alpha reductase inhibitors. <\/p>\n<p><strong>Objective<\/strong> &#x2014; To determine if there is an increased risk of suicide, self-harm, or depression among older men starting a 5-alpha reductase inhibitor for prostatic enlargement. <\/p>\n<p><strong>Design <\/strong>&#x2014; Population-based, retrospective, matched cohort study using linked administrative data. <\/p>\n<p><strong>Setting<\/strong> &#x2014; Ontario, Canada from 2003 through 2013. <\/p>\n<p><strong>Participants<\/strong> &#x2014; 93,197 men &#x2265;66 years of age who initiated a new prescription for a 5-alpha reductase inhibitor during the study period were matched (using a propensity score which included 44 or our 96 covariates which included medical comorbidities, medication usage, and healthcare system utilization) to an equal number of men not prescribed a 5-alpha reductase inhibitor. <\/p>\n<p><strong>Exposure<\/strong> &#x2014; Duration of finasteride or dutasteride usage. <\/p>\n<p><strong>Primary Outcome<\/strong> &#x2014; Suicide. Secondary outcomes were self-harm and depression. <\/p>\n<p><strong>Results<\/strong> &#x2014; Men who used 5-alpha reductase inhibitors were not at a significantly increased risk of suicide (HR 0.88, 95% CI 0.53 to 1.45). Risk of self-harm was significantly increased during the 4 initial 18 months after 5-alpha reductase inhibitor initiation (HR 1.88, 95% CI 1.34 to 2.64), but not thereafter. Incident depression risk was elevated during the initial 18 months after 5-alpha reductase inhibitor initiation (HR 1.94, 95% CI 1.73 to 2.16), and continued to be elevated, but to a lesser degree for the remainder of the follow-up period (HR 1.22, 95% CI 1.08 to 1.37). The absolute increase in the event rates for these two outcomes were 17\/100,000 patient years and 272\/100,000 patient years respectively. The type of 5-alpha reductase inhibitor (finasteride or dutasteride) did not significantly modify the observed associations with suicide, self-harm and depression. <\/p>\n<p><span class=\"bold\">Conclusions and Relevance<\/span> &#x2014; In a large cohort of men &#x2265;66 years of age, we did not demonstrate an increased risk of suicide associated with 5-alpha reductase inhibitor use. However, the risk of self-harm and depression were increased compared to unexposed men. This is in keeping with post-marketing experience and patient concerns, and discontinuation of the medication in these circumstances may be appropriate. <\/p>\n","protected":false},"excerpt":{"rendered":"<p>Importance &#x2014; There have been concerns raised by patients and regulatory agencies regarding serious psychiatric side effects associated with 5-alpha reductase inhibitors. Objective &#x2014; To determine if there is an increased risk of suicide, self-harm, or depression among older men starting a 5-alpha reductase inhibitor for prostatic enlargement. Design &#x2014; Population-based, retrospective, matched cohort study [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[49,34],"migration-helper-qa-sample-set":[],"class_list":["post-3740","journal_article","type-journal_article","status-publish","hentry","topic-kidney-disease","topic-mental-health-and-addictions"],"acf":{"citation":"Welk B, McArthur E, Ordon M, Anderson KK, Hayward J, Dixon S. <em>JAMA Intern Med.<\/em> 2017; 177(5):683-91. Epub 2017 Mar 20.","source_url":"http:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2610105","ices_scientist":[1131,1308,1377,1208],"site":[6739],"research_program":[6743],"news_release":[7598],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"FAED7CE8-FEA7-4F62-BEA3-3AFA037DB3B0","sitecore_item_name":"Association-of-suicidality-and-depression-with-5alpha-reductase-inhibitors","sitecore_field_values":"{\n  \"__Valid from\": \"20170320T114600\",\n  \"Title\": \"Association of suicidality and depression with 5alpha-reductase inhibitors\",\n  \"Short title\": \"Association of suicidality\",\n  \"Summary\": \"In a large cohort of men 66 years of age or older, the researchers did not find an increased risk of suicide associated with 5-alpha reductase inhibitor use.\",\n  \"Citation\": \"<p>Welk B, McArthur E, Ordon M, Anderson KK, Hayward J, Dixon S. <em>JAMA Intern Med.<\/em> 2017; 177(5):683-91. Epub 2017 Mar 20.<\/p>\",\n  \"Abstract\": \"<p><strong>Importance<\/strong> &mdash; There have been concerns raised by patients and regulatory agencies regarding serious psychiatric side effects associated with 5-alpha reductase inhibitors. <\/p>n<p><strong>Objective<\/strong> &mdash; To determine if there is an increased risk of suicide, self-harm, or depression among older men starting a 5-alpha reductase inhibitor for prostatic enlargement. <\/p>n<p><strong>Design <\/strong>&mdash; Population-based, retrospective, matched cohort study using linked administrative data. <\/p>n<p><strong>Setting<\/strong> &mdash; Ontario, Canada from 2003 through 2013. <\/p>n<p><strong>Participants<\/strong> &mdash; 93,197 men &ge;66 years of age who initiated a new prescription for a 5-alpha reductase inhibitor during the study period were matched (using a propensity score which included 44 or our 96 covariates which included medical comorbidities, medication usage, and healthcare system utilization) to an equal number of men not prescribed a 5-alpha reductase inhibitor. <\/p>n<p><strong>Exposure<\/strong> &mdash; Duration of finasteride or dutasteride usage. <\/p>n<p><strong>Primary Outcome<\/strong> &mdash; Suicide. Secondary outcomes were self-harm and depression. <\/p>n<p><strong>Results<\/strong> &mdash; Men who used 5-alpha reductase inhibitors were not at a significantly increased risk of suicide (HR 0.88, 95% CI 0.53 to 1.45). Risk of self-harm was significantly increased during the 4 initial 18 months after 5-alpha reductase inhibitor initiation (HR 1.88, 95% CI 1.34 to 2.64), but not thereafter. Incident depression risk was elevated during the initial 18 months after 5-alpha reductase inhibitor initiation (HR 1.94, 95% CI 1.73 to 2.16), and continued to be elevated, but to a lesser degree for the remainder of the follow-up period (HR 1.22, 95% CI 1.08 to 1.37). The absolute increase in the event rates for these two outcomes were 17\/100,000 patient years and 272\/100,000 patient years respectively. The type of 5-alpha reductase inhibitor (finasteride or dutasteride) did not significantly modify the observed associations with suicide, self-harm and depression. <\/p>n<p><span class=\"bold\">Conclusions and Relevance<\/span> &mdash; In a large cohort of men &ge;66 years of age, we did not demonstrate an increased risk of suicide associated with 5-alpha reductase inhibitor use. However, the risk of self-harm and depression were increased compared to unexposed men. This is in keeping with post-marketing experience and patient concerns, and discontinuation of the medication in these circumstances may be appropriate. <\/p>n<p><a href=\"http:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2610105\" title=\"Opens full text in external link \">View full text<\/a><\/p>\",\n  \"Keywords\": \"{60C09FC0-4360-4F20-9FB9-4D310EEBEAD4}|{2F71DDAB-66C2-4A75-98CB-6585AF1C4760}|{A42B9A82-A9B2-42CC-BD2F-105B04B0A51E}\",\n  \"Research Programs\": \"{92CC48EB-79AA-49F6-8A80-16D185170261}\",\n  \"ICES Locations\": \"{3B4AF7E8-6835-410B-AEB8-360A79CA0ED8}\",\n  \"ICES Scientists\": \"{2DB8D651-B762-43DF-B5EA-4963059DD5DE}|{F41ECBF4-504D-4062-83A6-449CB6D234AB}|{358406B5-5200-44A2-B01B-FCDD5B74FC1D}|{5B35E46C-9FBF-426F-A11D-1F64B8E9658E}\",\n  \"Posted Date\": \"20170320T000000\",\n  \"Show on Publications Landing Page\": \"1\",\n  \"In The News\": \"{DD6E32D7-8DC7-4A54-9AB5-53E48BADD1D9}\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2017\/March\/Association-of-suicidality-and-depression-with-5alpha-reductase-inhibitors"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Association of suicidality and depression with 5alpha-reductase inhibitors<\/title>\n<meta name=\"description\" content=\"Importance &#x2014; There have been concerns raised by patients and regulatory agencies regarding serious psychiatric side effects associated with 5-alpha\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/association-of-suicidality-and-depression-with-5alpha-reductase-inhibitors\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ICES | Association of suicidality and depression with 5alpha-reductase inhibitors\" \/>\n<meta property=\"og:description\" content=\"Importance &#x2014; There have been concerns raised by patients and regulatory agencies regarding serious psychiatric side effects associated with 5-alpha\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/association-of-suicidality-and-depression-with-5alpha-reductase-inhibitors\/\" \/>\n<meta property=\"og:site_name\" content=\"ICES\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/ICESOntario\/\" \/>\n<meta property=\"article:modified_time\" content=\"2023-06-14T23:31:04+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2024\/11\/ic-es-data-discovery-better-health-logo.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"675\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/association-of-suicidality-and-depression-with-5alpha-reductase-inhibitors\\\/\",\"url\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/association-of-suicidality-and-depression-with-5alpha-reductase-inhibitors\\\/\",\"name\":\"ICES | Association of suicidality and depression with 5alpha-reductase inhibitors\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#website\"},\"datePublished\":\"2017-03-20T04:00:00+00:00\",\"dateModified\":\"2023-06-14T23:31:04+00:00\",\"description\":\"Importance &#x2014; 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