Hair loss associated with escitalopram but not with venlafaxine: a case report.

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 (MINI) 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 decided. 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 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.