Neuropsychiatric Reactions to Finasteride: Nocebo or True Effect?

Reports to the FDA of neuropsychiatric events for finasteride in comparison to control medications show disproportionate safety signals for finasteride with a striking increase in suicides. Increased reporting could relate to enhanced awareness and not to a nocebo effect. In pharmacovigilance surveys, the actual rate of serious adverse effects on mood from finasteride in some patients may be diluted by the beneficial cosmetic outcome in many others. Health care professionals should be aware of these concerns and share them with patients to allow informed decision regarding their care.