My friend, L was just prescribed Lithium. She will not take it because
she has heard that it causes hair loss, and wanted me to investigate
if there were an alternative to it that doesn't cause hair loss.
She is typical manic/depressive-always has a few projects in the air,
little sleeping and quite self-agrandizing.She isn't always too easy
to be around.
(Geez, I could uses an hour or two of self-agrandizing behavior. If I
ever had it, perhaps I was asleep. Oh well, what are you going to do?)
Any ideas for L?

Thanks in anticipation of the brilliant answer from my favorite Googling Team,
Yesmam

Hello again Yesmam,

Thank you for yet another out-of-the ordinary, though certainly far
from being a hair-raising question!  :-)

?Toxic Alopecia? is the medical term for hair loss (sometimes called
?Medication-induced alopecia?) caused by physical or psychological
stress, and occurs  in 12-19% of long-term lithium users. The actual
cause of hair loss in a person taking lithium is hypothyroidism,
secondary to the lithium regimen. Low levels of thyroid hormone are to
blame for the hair loss.
Read more about hypothyroidism here:
http://health.discovery.com/diseasesandcond/encyclopedia/1571.html

 ?Some drugs--including chemotherapy drugs, blood pressure drugs,
lithium, valproate, oral contraceptives, vitamin A, and retinoids--can
also cause the condition? According to Merck, the hair may fall out at
the beginning of a drug therapy, or up to 3-4 months later. It is
usually a passing condition, and the hair does regrow.
Merck. Occasionally the hair can change color and even texture while
taking lithium.
http://www.merck.com/mrkshared/mmanual_home2/sec18/ch207/ch207c.jsp
and
Hair Loss in Pharmacology, Mercke Y, Sheng H, Khan T, Lippmann S
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10798824&dopt=Abstract
and
The Prescriber?s Letter
http://www.fhma.com/drugs_causing_hair_loss.htm

?Certain drugs, such as amphetamines, anticancer agents, gout
medication, isotretinoin (Accutane), lithium, male hormones,
propranolol hydrochloride (Inderal), and valproic acid (Depacon,
Depakene, Depakote), also can cause hair loss.?
PostGraduate Medicine Online
http://www.postgradmed.com/issues/2003/01_03/pn_hair.htm

Read about others experience with lithium and hair loss:
http://bipolar.about.com/cs/experience/a/sfe_lithspecsfx.htm


As I combed through the literature, I found several alternatives to
lithium. I must remind you that your friend?s doctor is the best
person to prescribe medication. She/he is familiar with her condition,
and knows best what will work for her. I would not brush aside the
medical opinions of many, that lithium is still the drug of choice,
with valproate a close second. Some of the alternatives have their own
side effects, and it appears that most bipolar medications can cause
hair loss also. Since fewer than 20% of folks who take lithium
actually suffer hair loss, your friend has an 80% chance of NOT losing
her hair! (As noted, the hair loss is not a permanent condition.)

Alternatives to Lithium:

Zyprexa:
?The drug Zyprexa is more effective than lithium in helping people
with bipolar disorder, says a study presented at a recent European
conference on the illness?
http://www.hon.ch/News/HSN/509180.html

Zyprexa Caveat:
?The adverse Zyprexa bipolar reports were so concerning that Japanese
and British officials issued warnings of the possibility of suffering
hyperglycemia and diabetes. The consumer watchdog group Public Citizen
thinks that U.S. officials have not warned physicians and patients as
well as other countries of the Zyprexa bipolar adverse event reports?
http://www.adrugrecall.com/zyprexa/bipolar.html

Carbamazepine and valproate 
?Two anti-epileptic drugs, carbamazepine and valproate, are well
established as alternatives to lithium for treating mania and as mood
stabilisers in manic depression, but not for depression.?
Mind.org.uk
http://www.mind.org.uk/Information/Factsheets/Treatments+and+drugs/Alternatives+To+Lithium+carbamazepine+and+valproate.htm

However, this study, ?Lithium versus carbamazepine in the maintenance
treatment of bipolar disorders--a randomised study?, Greil W,
Ludwig-Mayerhofer W, Erazo N, Schochlin C, Schmidt S, Engel RR,
Czernik A, Giedke H, Muller-Oerlinghausen B, Osterheider M, Rudolf GA,
Sauer H, Tegeler J, Wetterling T., Psychiatric Hospital, University of
Munich, Germany, concludes   ?Lithium seems to be superior to
carbamazepine in maintenance treatment of bipolar disorder, in
particular when applying broader outcome criteria including
psychotropic comedication and severe side effects.?
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9165384&dopt=Abstract

?Valproate may have greater acceptability than lithium among patients
with bipolar disorder and substance use disorder. Clinicians should
also be aware that these patients may take higher doses of medication
than prescribed.?
Biopsychiatry
http://www.biopsychiatry.com/valvlith.htm
?Because of its relative safety, it can be administered in high doses
as an oral loading therapy, with approximately 60% to 70% of patients
showing a favorable response?
Biopsychiatry
http://www.biopsychiatry.com/valman.htm

?Valproate has become a leading adjunctive and alternative treatment
to lithium in bipolar disorder?
Cochrane.org
http://www.cochrane.org/cochrane/revabstr/AB004052.htm
From Internet Mental Health, is a chart outlining bipolar disorder.
http://www.mentalhealth.com/dis/p20-md02.html

Well, Yesmam, I hope this answer will help detangle the lithium issue
for your friend. What a kind friend you are!

Sincerely,
crabcakes


Search Terms
Alopecia lithium
Lithium alternatives

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Request for Answer Clarification by yesmam-ga on 23 Apr 2004 09:04 PDT

Hello Crab-I'm not sure what clarification you need. Your answer is
really good as usual and I thank you.

Yesmam

---

Clarification of Answer by crabcakes-ga on 23 Apr 2004 11:22 PDT

Hi yesmam, 

Thanks you for the stars and tips. Actually, it was not me who
requested a clarification!

I believe Google Answers may have hiccupped....many of us researchers
received notification of clarifications that we did not request! It
was good hearing from you never the less!

Your questions are fun and interesting, and a pleasure to research!

Regards,
crabcakes

crabcakes wrote: "Thank you for yet another out-of-the ordinary,
though certainly far from being a hair-raising question! :-)"

Geez, crab, the compliments do really well by me. Are my questions so
out of the ordinary and what is an ordinary question and why can't
people answer the ordinary questions for themselves?
Is there an epidemic of people who are "B.B.B?" You know-boring beyond belief.

Love your helping me out.

Yesmam

Dear Yesmam

I know someone who bravely suffered temporary hair loss, as a result
of medical treatment. It was a known risk.

She bought a wig and looked sensational.

In fact, wigs invariably look better than the real thing.

Please tell L to go ahead: hair loss may not happen and, even if it
does, she is sure to look fantastic in a wig.

PB

When taking various anticonvulsants like lithium and valproic acid, my
doctor recommended that I increase my intake of selenium to help
counteract the hair loss.  For some reason, he had noticed that the
two were connected.  The increase in selenium wasn't huge, mind you,
just switch multivitamins to Centrum Silver or some other higher
selenium multi-vitamin.

I recommend that she raise this issue and any other 'odd' concerns
with her physician when they next meet.  Losing one's hair could
certainly add stress to a mood disorder and increase the likelyhood
that one would stop taking meds properly.

I wish your friend the best.  
-phiguru