Hypothesis / aims of study
Post-drug syndrome (PDS) is a condition that results from persistent side effects after withdrawing a medication. This can arise from various drugs including antidepressants (SSRI, SNRI, TCA), isotretinoin and finasteride. While these are different drug classes, their side effects appear to be similar. Through an international online survey, we sought to compare the symptoms of PDS caused by each of these drug classes.
Study design, materials and methods
An anonymous Qualtrics survey was distributed via online support forums and social media platforms, such as X, Reddit, and Facebook targeting individuals over the age of 18 who reported persistent symptoms post antidepressant, finasteride or Accutane use.
Results
A total of 827 men (78.1%) and women (21.9%) were enrolled in the study, of which 380 previously used antidepressants (AntiD), 333 finasteride and 114 isotretinoin. Those taking finasteride were best informed about sexual dysfunction (SD) being a potential side effect (38.3%), while only 12.9% and 5.3% of AntiD and isotretinoin group were informed about SD. While taking the medication, SD was most prominent in AntiD (88.9%) and finasteride (87.3%) groups compared to 50.1% in isotretinoin cohort. The incidence of SD increased to 96.3%, 94.4% and 65.8% respectively after drug cessation. For each of these drug classes, approximately 2% of individuals saw full resolution of SD after drug cessation, while 8.9-11.7% had new onset of SD. In addition, for all drug classes, 50-55% of patients reported worsening of SD after drug cessation. In each of the cohorts, most respondents (87.7-93.3%) reported other symptoms such as cognitive impairment, mood changes, anhedonia and visual changes. The development of PDS had a significant impact on mental health for each of the drug classes. Before starting medication, 90.7% of AntiD, 46.2% of isotretinoin and 44% of finasteride respondents had some degree of depression/anxiety (mild – severe). After stopping, depression decreased in the AntiD group to 81.1% while, the isotretinoin and finasteride groups saw an increase to 84.6% and 90.5% respectively. Finally, thoughts of suicide or about wanting to hurt themselves were most prevalent in the finasteride cohort (64.8%), followed by the AnitD group at 61.1% and the isotretinoin group at 51%.
Interpretation of results
Our results indicate that patients that are actively taking or have previously taken finasteride or AntiD are more commonly experiencing sexual dysfunction then those on isotretinoin. Furthermore, people with history of taking isotretinoin had the lowest suicide rate. On the other hand, other non-sexual symptoms were equally common among each of the drug classes. Thus, while there was significant symptom overlap between the different drug classes, post-isotretinoin symptoms were overall less severe than that of prior AntiD and finasteride users.