I didn’t have mental problems on my first go with finasteride until around the time I quit. I noticed I was getting anxiety and close to panic attacks but this all normalized a month or so after stopping.
Cognitively I don’t feel at my best, but I’m good enough to function at work. In my case I think my anxiety was making cognition worse, as I was close to panic attacks most days which sent me into a state of feeling derealized and dizzy. Once I got my anxiety under control, I felt way better cognitively but I still experience a bit of brain fog at most times where I don’t feel 100% normal, but it’s livable.
As for medication I’ve been taking lexapro for the last month which completely obliterated my anxiety at a low dose but left me more depressed and apathetic so I was switched to Trintellix a week ago. Right now I’m a little bad off anxiety wise but it was like this with the lexapro until my brain adjusted. One benefit of the Trintellix is that it’s been shown to actually improve cognition in a few studies. One thing that worries me is that it functions inversely to fluoxetine in the sense that it inhibits Gaba somewhat while fluoxetine increases allopregnanolone and Gaba activity (which is why some people on here have taken it for brain fog) I’ll just have to see how it plays out for me I guess
I don’t want to come off as saying anyone should take these meds, as a popular theory is that if you’re predisposed to pfs you’re predisposed to pssd. I hope this isn’t the case as I’ve actually been better off sexually since starting the meds, but I didn’t see many other options in my case.