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Q: lexapro ( Answered 4 out of 5 stars,   0 Comments )
Question  
Subject: lexapro
Category: Health > Medicine
Asked by: anonymous777-ga
List Price: $100.00
Posted: 06 Jan 2003 09:02 PST
Expires: 05 Feb 2003 09:02 PST
Question ID: 138265
can lexapro cause hairloss? i read that other anti-depressants can
cause hairloss but i dont know about this one because its very new???
find out all that u can about this drug and hairloss. find
testamoinals and or people saying it cuased them hairloss.  i need to
know how other antidepressants caueses hairloss as well. and please
finf out if this anti depressant is supposed to be real good. iv been
on it for 2 weeks and i dont feel much yet.
Answer  
Subject: Re: lexapro
Answered By: kevinmd-ga on 06 Jan 2003 11:07 PST
Rated:4 out of 5 stars
 
Hello,
Thanks for asking your question.  Although I am an internal medicine 
physician, please see your primary care physician for specific 
questions regarding any individual cases – please do not use Google 
Answers as a substitute for medical advice.  I will be happy to answer
factual medical questions.  You asked the following.

“Can lexapro cause hairloss? Find out all that u can about this drug
and hairloss. Find testamoinals and or people saying it cuased them
hairloss.  I need to know how other antidepressants caueses hairloss
as well.  Find out if this anti depressant is supposed to be real
good. I’ve been on it for 2 weeks and i dont feel much yet.”

I will address your concerns individually.

1) Can lexapro cause hair loss?  Find out all that you can about this
drug and hair loss.  Find testimonials and/or people saying it caused
them hair loss.

The short answer is yes.  Here are the details. 

From RXList:
“LEXAPRO™ (escitalopram oxalate) is an orally administered selective
serotonin reuptake inhibitor (SSRI).”
http://www.rxlist.com/cgi/generic/lexapro.htm

Thus, it is in the same class as sertraline (zoloft), fluoxitine
(prozac), and paroxetine (paxil).  I will research the connection
between the SSRIs and hair loss (otherwise called alopecia).

There have been several case-studies connecting SSRIs specifically and
hair loss.

From the Canadian Psychiatric Association:
“Hair Loss Associated with Sertraline Treatment 

Dear Editor:

Hair loss is a common adverse event with chemotherapeutic agents.
Although not a common side effect, it can also be associated with the
selective serotonin reuptake inhibitor (SSRI) antidepressants. There
have been reports of hair loss associated with fluoxetine (1–3),
fluvoxamine (4), nefazodone (5), paroxetine (6,7) and sertraline (8).
By 1994 Eli Lilly, the manufacturers of fluoxetine, had reported on
725 cases of hair loss. For patients identified by sex, 540 were women
and 73 were men (9). In 1998 Solvay Pharma, the manufacturer of
fluvoxamine, reported a hair-loss incidence of 0.02%, and sertraline’s
manufacturer, Pfizer, reported an incidence of 1.0% (10). Wheatley
reports that seven patients experienced hair loss during the first
three years of the marketing of paroxetine in the United Kingdom. This
included at least four female patients and one male patient (6). Hair
loss onset seems to vary from a few days to months and appears to
discontinue on cessation of the medication or switching to a different
SSRI.

Human hair follicles have two primary cyclical phases: the anagen
(growth) and telogen (resting) phase. The telogen phase lasts
approximately three months and culminates in the shedding of the hair
shaft. It is thought that most psychotropic medications that cause
hair loss affect the telogen phase of the hair cycle (10). However,
hair loss with one antidepressant will not necessarily reoccur with a
different one, even of the same class (5,8).

A 31-year-old physically healthy man was initially prescribed
Sertraline 100 mg daily by his family doctor. Within four to six weeks
he reported that chunks of his hair were falling out and covering the
bed pillow and washbasin. The sertraline was decreased and
discontinued, and he was prescribed paroxetine 20 mg daily. Within six
weeks his hair had stopped falling out completely, and at three months
his hair loss had not reoccurred. Of course, to confirm that
sertraline was the offending agent one would need to reinstitute it,
but this was not a clinical option for this patient.

From the literature to date, hair loss with SSRIs appears to be
reported more often in women, but we should be aware that it can also
occur in men. Therefore, we should maintain a high index of suspicion
when sudden hair loss starts to develop in a male patient on SSRI
antidepressant medication.”
http://www.cpa-apc.org/Publications/Archives/Bulletin/2002/june/letterToEditor.asp

Zalsman et al. (1999) reports on a case between paxil and hair loss:
“Alopecia and hair loss are rare side effects of psychotropic drugs.
There are a few case reports on hair loss associated with tricyclic
antidepressants and serotonin selective reuptake inhibitors (SSRIs),
but none deal specifically with paroxetine. We report on a 37-year-old
female who complained of moderate hair loss during paroxetine
treatment. Findings on discontinuation and rechallenge supported the
assumption that the hair loss was a side effect of the paroxetine.
Further investigation is needed to determine the scope of this
troubling side effect.” (5)

2) I need to know if other antidepressants causes hair loss as well.

Hair loss can occur with antipressants other than SSRIs.

Mercke et al. (2000) studies hair loss with several psychotropic
medications including lithium, tricyclic antidepressants, trazodone,
and buspirone:
“Medication-induced alopecia is an occasional side effect of many
psychopharmaceuticals. Most of the mood stabilizer and antidepressant
drugs can lead to this condition. Some antipsychotic and antianxiety
agents induce alopecia. Hair loss is also related to hypothyroidism,
which can be induced by lithium and other agents. Alopecia might not
be reported by some people, but physicians should be aware of this
potential problem which may contribute to noncompliance. Lithium
causes hair loss in 12-19% of long-term users. Valproic acid and/ or
divalproex precipitates alopecia in up to 12% of patients in a
dose-dependent relationship. Incidences up to 28% are observed with
high valproate concentration exposures. These pharmaceuticals also can
change hair color and structure. The occurrence of
carbamazepine-induced alopecia is at or below 6%. Hair loss is less
common with other mood stabilizers. Tricyclic antidepressants,
maprotilene, trazodone, and virtually all the new generation of
antidepressants may on rare occasions lead to alopecia. The same
applies to haloperidol, olanzepine, risperidone, clonazepam, and
buspirone, but not to other neuroleptics, benzodiazepines, or
barbiturates, selected antihistamines, and antiparkinsonians.
Discontinuation of the medication or dose reduction almost always
leads to complete hair regrowth. The therapeutic value of mineral
supplements remains unclear.” (1)

In this case report by Pitchot et al. (2001), he reports a link
between venlafaxine (a different class of antidepressant) and hair
loss:
“Ms. A was a 50-year-old woman who had suffered from a severe major
depressive episode of a melancholic subtype. She did not fulfill
DSM-IV criteria for any other axis I or personality disorder. She was
medically healthy and did not take any medications. Her general
practitioner began treatment with venlafaxine, 75 mg/day. After 15
days, her dose of venlafaxine was increased to 150 mg/day. Four weeks
later, Ms. A was much better. However, she reported moderate side
effects, such as nausea and somnolence, that began after 2 days of
treatment. After 2 weeks, she also noticed hair loss when she brushed
or washed her hair. Ms. A considered hair loss a moderate but
disturbing side effect and decided to discontinue the treatment after
3 months. Her hair loss stopped completely 1 month later.

Ten months later, Ms. A developed a new major depressive episode. She
began taking venlafaxine again; this was associated with a complete
remission of the previous depressive episode. She started taking
venlafaxine at a mean dose of 75 mg/day and then increased it to 150
mg/day after 2 weeks. Three weeks later, Ms. A decided to stop taking
the medication again because of the hair loss that she had observed 10
days after beginning treatment. A complete remission was achieved with
sertraline, 50 mg/day, without hair loss, which completely stopped 3
weeks after the discontinuation of venlafaxine.

Our patient had never experienced hair loss before and had no history
of endocrine illness. Hair loss has been reported with selective
serotonin reuptake inhibitors such as fluoxetine (3), sertraline (4),
and paroxetine (5), but it is considered a rare side effect. To our
knowledge, this is the first report of hair loss associated with
venlafaxine therapy. Clinicians should be aware of this surprising and
potentially distressing side effect.” (2)

The Western Pennsylvania Hospital states that antidepressant
medications in general can cause temporary hair loss:
“What can cause temporary hair loss?
Causes of temporary hair loss include:
 stress related to illness, major surgery, or childbirth; 
 hormonal imbalances, including too much or too little thyroid
hormone or sex hormones (androgens or estrogens);
 medications, including anticoagulant ("blood thinning") medications,
medications used to treat gout, chemotherapy, high doses of vitamin A,
birth control pills, and antidepressant medications;
 fungal infection of the scalp; and 
 trauma to the hair. “
http://www.asri.edu/wph/doctor/w07hairloss.html

AndrogenicAlopecia.com gives multiple antidepressant medications that
can cause hair loss (also medically called anagen or telogen
effluvium):
“Common drugs causing anagen or telogen effluvium 
The most common drug categories and examples of drugs causing anagen
effluvium type hair loss are listed below. This is by no means an
exhaustive list of drugs known to promote hair loss.
 Alkylating agents, Cyclophosphamide, Nitrogen Mustard, Chlorambucil,
Thiotepa
 Antimetabolic agents, Methotrexate, 5-Fluorouracil, Fluorouracin,
6-Mercaptopurine
 Cytostatic drugs, Colchicine, Actinomycin D, Vinblastine,
Vincristine, Cytosine, Doxorubicine, Arabinoside
 Antipsychotic drugs, Fluorobutyrophenone 
 Antidepressant drugs, Valproic acid, Divalproex, Carbamazepine,
Maprotilene, Trazodone, Haloperidol, Olanzepine, Risperidone,
Clonazepam, Buspirone, Paroxetine, Fluoxetine, Sertraline
 Anticholesterinic drugs, Triparanol 
 Vitamin A derivative drugs, Retinoids, Retinol, Acitretin ,
Isotretinoin, Etretinate, Vitamin A
 Amino acid, Mimosine 
 Other drugs, Bleomycin, cytarabine, Mitomycin, Dactinomycin,
Mitoxantrone, Daunorubicin, Procarbazine, Thioguanine, Etoposide,
Floxuridine, Fluconazole”
http://www.androgeneticalopecia.com/ao/ao004.shtml

Dr. Richard Lee from Hair Loss Help provides a link between hair loss
and antidepressants (essentially a summary of the Mercke article that
I cited earlier):
“Brian asked: "I have severe depression and anxiety/social anxiety
over my hair loss and I was wondering if you know of any
anti-depressant medications that could help me with this problem and
not cause added hair loss due to the meds, while I am waiting for a
cure to hair loss? I need to find an anti-depressant that will not
cause added hair loss and one that will not cause weight gain. Any
help or suggestions Dr. Lee?"

Dr Richard Lee, MD answered: "Hair loss has been reported with
essentially all of the drugs used in psychopharmacology, but the
incidence of hair loss as a side effect shows a wide variation.
Here’s an edited abstract from an article entitled, “Hair Loss in
Psychopharmacology” by Mercke Y, Sheng H, Khan T, and Lippmann S. from
the Annals of Clinical Psychiatry 2000 Mar;12(1):35-42 :
Medication-induced alopecia is an occasional side effect of many
psychopharmaceuticals. Most of the mood stabilizer and antidepressant
drugs can lead to this condition. Some antipsychotic and antianxiety
agents induce alopecia. Valproic acid (e.g. Depakene) and/ or
divalproex precipitates alopecia in up to 12% of patients in a
dose-dependent relationship. Incidences up to 28% are observed with
high valproate concentration exposures. These pharmaceuticals also can
change hair color and structure. The occurrence of carbamazepine (e.g.
Tegretol)-induced alopecia is at or below 6%. Hair loss is less common
with other mood stabilizers. Tricyclic antidepressants, maprotilene,
trazodone, and virtually all the new generation of antidepressants may
on rare occasions lead to alopecia. The same applies to haloperidol,
olanzepine, risperidone, clonazepam, and buspirone, but not to other
neuroleptics, benzodiazepines, or barbiturates, selected
antihistamines, and antiparkinsonians. Discontinuation of the
medication or dose reduction almost always leads to complete hair
regrowth.

Please don’t allow this daunting list intimidate you. The majority of
patients will not experience any hair loss as a result of taking an
anti-depressant. Even if a medication does cause hair loss, the loss
is almost always completely reversible. Many of the SSRI (Serum
Serotonin Re-uptake Inhibitors) are excellent anti-depressants with
very good safety records. Be sure to take antidepressants under close
medical supervision."
http://www.hairlosshelp.com/qna/Detail.Cfm?FAQID=3920&ExpertID=8

3) Find out if this anti depressant is supposed to be real good. I’ve
been on it for 2 weeks and I dont feel much yet.

Typically, you have to give antidepressants more time before you start
to feel anything (typically four to six weeks).

From UptoDate:
“Follow-up — An initial therapeutic response typically occurs within
four to six weeks of antidepressant therapy. There is little evidence
to support extending antidepressant therapy beyond six weeks in
patients who have shown no response. Patients who have a partial
response should continue with therapy for an additional two to four.
If there is no response by 8 to 12 weeks at a maximum therapeutic
dose, the patient should be given a trial of another antidepressant
(either of the same or different class). Alternatively, the patient
should be referred to a psychiatrist.

Patients need to check in at least every one to two weeks for six to
eight weeks during the initiation phase of medication treatment. More
severely depressed patients should be seen weekly, and less severely
ill patients every 10 to 14 days. Compliance may be enhanced by the
presence of telephone access to the clinician for the acute questions
a patient may have about side effects.
Treatment duration — Antidepressant medication generally should be
taken for at least six to nine months. There are strong data to
recommend maintenance therapy for patients with a history of three or
more depressive episodes and for those with two previous episodes plus
risk factors that would increase the risk of recurrence. I personally
recommend maintenance therapy for adults who have even one major
recurrence.” (6)

Lexapro has been found to work well.  The detailed clinical trials
testing the efficacy of lexapro can be found here:
http://www.rxlist.com/cgi/generic/lexapro_cp.htm

I stress that this answer is not intended as and does not substitute
for medical advice - please see your primary care physician for
further evaluation of your individual case.
  
Please use any answer clarification before rating this answer. I will
be happy to explain or expand on any issue you may have.
      
Thanks,       
Kevin, M.D.

Medline search:
SSRI and hair loss or alopecia
antidepressant and hair loss or alopecia

Hotbot search:
SSRI and hair loss
antidepressant and hair loss

Bibliography:
1) Mercke Y. Sheng H. Khan T. Lippmann S. Hair loss in
psychopharmacology. [Review] [81 refs] Annals of Clinical Psychiatry.
12(1):35-42, 2000 Mar.

2) Pitchot W. Ansseau M. Venlafaxine-induced hair loss. American
Journal of Psychiatry. 158(7):1159-60, 2001 Jul.

3) Jenike MA: Severe hair loss associated with fluoxetine use
(letter). Am J Psychiatry 1991; 148:392

4) Bourgeois JA: Two cases of hair loss after sertraline use (letter).
J Clin Psychopharmacol 1996; 16:91-92

5) Zalsman G, Sever J, Munitz H: Hair loss associated with paroxetine
treatment: a case report. Clin Neuropharmacol 1999; 22:246-2

6) Paulsen R. Treatment of depression.  UptoDate, 2002.

Links:
Canadian Psychiatric Association
http://www.cpa-apc.org/Publications/Archives/Bulletin/2002/june/letterToEditor.asp

RXList – Lexapro
http://www.rxlist.com/cgi/generic/lexapro.htm

RXList – Lexapro Adverse Effects
http://www.rxlist.com/cgi/generic/lexapro_ad.htm
anonymous777-ga rated this answer:4 out of 5 stars

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