Dear Editor:
Hair loss can be a rare side effect associated with psychotropic medication use. Exception is with mood stabilizers like valproate and lithium where it has been much more commonly reported.1
In the case of newer antidepressants literature mentions only a few case reports of hair loss associated with fluoxetine,2,3 sertraline,4,7 paroxetine,5 as well venlafaxine,6 and nefazodone.8 The pathological mechanism of hair loss is yet to be elucidated but it is known that most psychotropic medication causes hair loss in the telogen phase of hair cycle.1
Case report. A case of 14-year-old male child was on sertraline for five years for depression. He was doing well and was in full remission with a combined program of medication (sertraline [Zoloft®, Pfizer, Inc.] 50mg oral daily) and supportive psychotherapy. But last summer he started to lose small amounts of hair. The loss being very small was ignored and not reported by the patient until three months ago, when the family started to observe the presence of hair loss by noticing small bald spots on his scalp. The patient had not experienced hair loss before and had no history of endocrine illness.
He was referred to pediatrician and dermatologist. A comprehensive work-up of chemistry profile, blood counts, thyroid function tests, and ANA titers was normal. A dermatologist consult reported no specific cause for hair loss. Medication-induced alopecia was considered at that time. The sertraline was tapered gradually and discontinued. No new medication was started. Soon after the sertraline discontinuation, the patient's hair loss stopped.
Discussion. This case is unique in its own way. Unlike other reported cases this patient was only 14 years old (the first reported case in the adolescent population), and on a low dose of sertraline (unlike other cases). Important to note, the hair loss occurred in this patient after he had been on sertraline for several years, which differs from the other published literature cases that have reported the same adverse effect at the beginning of treatment.
The above case report reinforces the need for maintaining a high index of suspicion regarding any incident of sudden hair loss occurring in any age group while patients are on even low dose of antidepressant like sertraline.
With regards,
T. Rais, MD
Tanvir Singh, MD
A. Rais, MD
Medical College of Ohio Toledo, Ohio
References
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