<p class="frontmatter-fieldnotes disclaimernew" style="margin-bottom:15px;">This work may not be copied, distributed, displayed, published, reproduced, transmitted, modified, posted, sold, licensed, or used for commercial purposes. By downloading this file, you are agreeing to the publisher’s <a href="/pages/termsofuse.aspx" target="_blank">Terms & Conditions</a>.</p> <div id="x11l01146">
<div class="story">
<p class="ltrs-br-ltr-br-title">Hair Loss Associated With Escitalopram but Not With Venlafaxine: A Case Report</p>
<p class="ltrs-br-ltr-br-body-text"><span class="bold">To the Editor:</span> Here, I describe the case of a depressed woman who complained of hair loss with escitalopram, but not with venlafaxine.</p>
<p class="ltrs-br-ltr-br-body-text">&nbsp;</p>
<p class="ltrs-br-ltr-br-body-text"><span class="bold-italic">Case report.</span> Ms A, a 40-year-old woman, had suffered from a first episode of moderate major depressive disorder (<span class="italic">DSM-IV</span> criteria). According to the clinical interview and to the Mini-International Neuropsychiatric Interview questionnaire,<span class="htm-cite"><a href="#ref1">1</a></span> she did not fulfill <span class="italic">DSM-IV-TR</span> criteria for any other Axis I or personality disorder. She was medically healthy and took no medications. The patient was first treated with venlafaxine progressively increased to 225 mg/d. Ms A received venlafaxine (225 mg/d) during a total of 12 weeks. This treatment was not associated with a marked response (ie, no change on the Clinical Global Impressions-Improvement scale [CGI-I]). A switch from venlafaxine to escitalopram was initiated. After 4 weeks, escitalopram was associated with a substantial improvement (CGI-I: much improved). </p>
<p class="ltrs-br-ltr-br-body-text">However, after 3 weeks, Ms A noticed hair loss when she brushed or washed her hair. This observation was confirmed by the patient’s hairdresser. After about 3 months of treatment, the patient decided to discontinue escitalopram on her own initiative because hair loss was considered as an intolerable side effect. Two weeks later, hair loss stopped and the patient was reassured. About 2 months after the end of escitalopram treatment, Ms A presented with a depressive relapse. Her general practitioner prescribed escitalopram again. Despite the history of hair loss associated with escitalopram administration, the patient agreed to try it again because of its previous efficacy. After 2 weeks, the patient observed hair loss again. Complete remission was obtained with escitalopram 10 mg/d, which was continued during at least 3 months. Hair loss persisted.</p>
<p class="ltrs-br-ltr-br-body-text">&nbsp;</p>
<p class="ltrs-br-ltr-br-body-text">In this case, hair loss was associated with escitalopram but not with venlafaxine. To our knowledge, this is the first report of hair loss associated with escitalopram. However, hair loss has been previously reported with citalopram,<span class="htm-cite"><a href="#ref2">2</a></span> but also with other serotonin reuptake inhibitors such as sertraline,<span class="htm-cite"><a href="#ref3">3</a></span> paroxetine,<span class="htm-cite"><a href="#ref4">4</a></span> and fluoxetine<span class="htm-cite"><a href="#ref5">5</a></span> and with serotonin-norepinephrine reuptake inhibitors such as venlafaxine.<span class="htm-cite"><a href="#ref6">6</a></span> This is clearly an infrequent side effect,<span class="htm-cite"><a href="#ref7">7</a></span> but it is potentially distressing, mainly for women. Clinicians should be aware of this side effect.</p>
<p class="ltrs-br-ltr-br-references-head"><span class="smallcaps">References</span></p>
<p class="references-references-text-1-9"><a name="ref1"></a>1. <span class="bib-surname">Sheehan</span> <span class="bib-fname">DV</span>, <span class="bib-surname">Lecrubier</span> <span class="bib-fname">Y</span>, Janavs J, <span class="bib-etal">et al</span>. <span class="italic">Mini-International Neuropsychiatric Interview (MINI). </span>Tampa, Fla: University of South Florida, Institute for Research in Psychiatry, and Paris, <span class="bib-location">France</span>: <span class="bib-publisher">INSERM-Hôpital de la Salpêtrière</span>; <span class="bib-year">1994</span>.</p>
<p class="references-references-text-1-9"><a name="ref2"></a>2. <span class="bib-surname">Gupta</span> <span class="bib-fname">S</span>, <span class="bib-surname">Masand</span> <span class="bib-fname">PS</span>. <span class="bib-article">Citalopram and hair loss.</span> <span class="italic">Prim Care Companion J Clin Psychiatry</span>. <span class="bib-year">2000</span>;<span class="bib-volume">2</span>(<span class="bib-issue">2</span>):<span class="bib-fpage">61</span>–<span class="bib-lpage">62</span>. <span class="pubmed-crossref"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15014589&dopt=Abstract">PubMed</a> <a href="http://dx.doi.org/10.4088/PCC.v02n0208d">doi:10.4088/PCC.v02n0208d</a></span></p>
<p class="references-references-text-1-9"><a name="ref3"></a>3. <span class="bib-surname">Ghanizadeh</span> <span class="bib-fname">A</span>. <span class="bib-article">Sertraline-associated hair loss.</span> <span class="italic">J Drugs Dermatol</span>. <span class="bib-year">2008</span>;<span class="bib-volume">7</span>(<span class="bib-issue">7</span>):<span class="bib-fpage">693</span>–<span class="bib-lpage">694</span>. <span class="pubmed-crossref"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=18664165&dopt=Abstract">PubMed</a></span></p>
<p class="references-references-text-1-9"><a name="ref4"></a>4. <span class="bib-surname">Zalsman</span> <span class="bib-fname">G</span>, <span class="bib-surname">Sever</span> <span class="bib-fname">J</span>, <span class="bib-surname">Munitz</span> <span class="bib-fname">H</span>. <span class="bib-article">Hair loss associated with paroxetine treatment: a case report.</span> <span class="italic">Clin Neuropharmacol</span>. <span class="bib-year">1999</span>;<span class="bib-volume">22</span>(<span class="bib-issue">4</span>):<span class="bib-fpage">246</span>–<span class="bib-lpage">247</span>. <span class="pubmed-crossref"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10442258&dopt=Abstract">PubMed</a></span></p>
<p class="references-references-text-1-9"><a name="ref5"></a>5. <span class="bib-surname">O’Bryan</span> <span class="bib-fname">EC</span> <span class="bib-suffix">3rd</span>, <span class="bib-surname">Albanese</span> <span class="bib-fname">RP</span>. <span class="bib-article">A case report of fluoxetine- and venlafaxine-induced hair loss.</span> <span class="italic">Prim Care Companion J Clin Psychiatry</span>. <span class="bib-year">2004</span>;<span class="bib-volume">6</span>(<span class="bib-issue">4</span>):<span class="bib-fpage">181</span>. <span class="pubmed-crossref"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15361923&dopt=Abstract">PubMed</a> <a href="http://dx.doi.org/10.4088/PCC.v06n0407">doi:10.4088/PCC.v06n0407</a></span></p>
<p class="references-references-text-1-9"><a name="ref6"></a>6. <span class="bib-surname">Pitchot</span> <span class="bib-fname">W</span>, <span class="bib-surname">Ansseau</span> <span class="bib-fname">M</span>. <span class="bib-article">Venlafaxine-induced hair loss.</span> <span class="italic">Am J Psychiatry</span>. <span class="bib-year">2001</span>;<span class="bib-volume">158</span>(<span class="bib-issue">7</span>):<span class="bib-fpage">1159</span>–<span class="bib-lpage">1160</span>. <span class="pubmed-crossref"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11431245&dopt=Abstract">PubMed</a> <a href="http://dx.doi.org/10.1176/appi.ajp.158.7.1159-a">doi:10.1176/appi.ajp.158.7.1159-a</a></span></p>
<p class="references-references-text-1-9"><a name="ref7"></a>7. <span class="bib-surname">Hedenmalm</span> <span class="bib-fname">K</span>, <span class="bib-surname">Sundström</span> <span class="bib-fname">A</span>, <span class="bib-surname">Spigset</span> <span class="bib-fname">O</span>. <span class="bib-article">Alopecia associated with treatment with selective serotonin reuptake inhibitors (SSRIs).</span> <span class="italic">Pharmacoepidemiol Drug Saf</span>. <span class="bib-year">2006</span>;<span class="bib-volume">15</span>(<span class="bib-issue">10</span>):<span class="bib-fpage">719</span>–<span class="bib-lpage">725</span>. <span class="pubmed-crossref"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16783834&dopt=Abstract">PubMed</a> <a href="http://dx.doi.org/10.1002/pds.1270">doi:10.1002/pds.1270</a></span></p>
<p class="ltrs-br-ltr-br-author"><span class="bold">William Pitchot, MD, PhD</span></p>
<p class="ltrs-br-ltr-br-author"><a href="mailto:wpitchot@chu.ulg.ac.be" target="_blank">wpitchot@chu.ulg.ac.be</a></p>
<p class="ltrs-br-ltr-br-endmatter-fieldnotes"><span class="bold-italic">Author affiliation:</span> Department of Psychiatry, University of Liège, Liège, Belgium.</p>
<p class="ltrs-br-ltr-br-endmatter-fieldnotes"><span class="bold-italic">Potential conflicts of interest</span>: <span class="bold">Dr Pitchot</span> has served on the speakers or advisory boards for Lundbeck.</p>
<p class="ltrs-br-ltr-br-endmatter-fieldnotes"><span class="bold-italic">Funding/support: </span>None reported.</p>
<p class="ltrs-br-ltr-br-endmatter-fieldnotes"><span class="bold-italic">Published online:</span> August 18, 2011 (<span class="doi">doi:10.4088/PCC.11l01146</span>).</p>
<p class="ltrs-br-ltr-br-copyright-doi"><span class="italic">Prim Care Companion CNS Disord 2011;13(4):</span><span class="doi">doi:10.4088/PCC.11l01146</span></p>
<p class="ltrs-br-ltr-br-copyright-doi"><span class="italic">© Copyright 2011 Physicians Postgraduate Press, Inc.</span></p>
</div>
</div>