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Hair Loss: Escitalopram vs. Venlafaxine | Psychiatrist.com

Hair Loss Associated With Escitalopram but Not With Venlafaxine: A Case Report

To the Editor: Here, I describe the case of a depressed woman who complained of hair loss with escitalopram, but not with venlafaxine.

Case report. Ms A, a 40-year-old woman, had suffered from a first episode of moderate major depressive disorder (DSM-IV criteria). According to the clinical interview and to the Mini-International Neuropsychiatric Interview questionnaire,1 she did not fulfill DSM-IV-TR 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).

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.

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,2 but also with other serotonin reuptake inhibitors such as sertraline,3 paroxetine,4 and fluoxetine5 and with serotonin-norepinephrine reuptake inhibitors such as venlafaxine.6 This is clearly an infrequent side effect,7 but it is potentially distressing, mainly for women. Clinicians should be aware of this side effect.

References

1. Sheehan DV, Lecrubier Y, Janavs J, et al. Mini-International Neuropsychiatric Interview (MINI). Tampa, Fla: University of South Florida, Institute for Research in Psychiatry, and Paris, France: INSERM-Hôpital de la Salpêtrière; 1994.

2. Gupta S, Masand PS. Citalopram and hair loss. Prim Care Companion J Clin Psychiatry. 2000;2(2):6162. PubMed doi:10.4088/PCC.v02n0208d

3. Ghanizadeh A. Sertraline-associated hair loss. J Drugs Dermatol. 2008;7(7):693694. PubMed

4. Zalsman G, Sever J, Munitz H. Hair loss associated with paroxetine treatment: a case report. Clin Neuropharmacol. 1999;22(4):246247. PubMed

5. O’ Bryan EC 3rd, Albanese RP. A case report of fluoxetine- and venlafaxine-induced hair loss. Prim Care Companion J Clin Psychiatry. 2004;6(4):181. PubMed doi:10.4088/PCC.v06n0407

6. Pitchot W, Ansseau M. Venlafaxine-induced hair loss. Am J Psychiatry. 2001;158(7):11591160. PubMed doi:10.1176/appi.ajp.158.7.1159-a

7. Hedenmalm K, Sundström A, Spigset O. Alopecia associated with treatment with selective serotonin reuptake inhibitors (SSRIs). Pharmacoepidemiol Drug Saf. 2006;15(10):719725. PubMed doi:10.1002/pds.1270

William Pitchot, MD, PhD

wpitchot@chu.ulg.ac.be

Author affiliation: Department of Psychiatry, University of Liège, Liège, Belgium.

Potential conflicts of interest: Dr Pitchot has served on the speakers or advisory boards for Lundbeck.

Funding/support: None reported.

Published online: August 18, 2011 (doi:10.4088/PCC.11l01146).

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