A Case Report of Fluoxetine- and Venlafaxine-Induced Hair Loss.

Abstract

Sir: We report on a woman with generalized anxiety disorder who complained of hair loss during treatment with fluoxetine as well as during subsequent treatment with venlafaxine. Case report. Ms. A, a 49-year-old woman, had been diagnosed with DSM-IV generalized anxiety disorder. She did not fulfill DSM-IV criteria for any other Axis I or personality disorder. She suffered from osteopenia and bursitis, but was otherwise medically healthy during the time of treatment for generalized anxiety disorder. Her medications during the course of treatment were alendronate, 70 mg weekly, and ibuprofen, 800 mg p.r.n. for pain. Her primary care provider initiated therapy with fluoxetine, 20 mg/day, and within 3 months, Ms. A achieved almost complete remission of anxiety symptoms. She noted some tinnitus and slight hair loss within the first 3 months of starting treatment with fluoxetine 20 mg, and subsequently the dose was reduced to 10 mg, with improvement in tinnitus but no improvement in hair loss. Ms. A continued taking fluoxetine, 10 mg/day, for over a year until she felt that her hair loss was becoming intolerable. She reported no longer having to shave her legs or axillary areas in addition to the continued loss of scalp hair. She eventually became concerned enough to stop treatment completely. Four weeks after stopping fluoxetine treatment, Ms. A's hair loss ceased and her hair returned to normal thickness. Six weeks after stopping fluoxetine treatment, Ms. A was prescribed venlafaxine, 50 mg/day, by her gynecologist and referred to a psychiatrist. Within 1 week, the patient's hair loss recurred, and she stopped taking venlafaxine. On initial assessment by a psychiatrist 2 weeks after stopping venlafaxine treatment, Ms. A reported renewed hair growth. At this point, it was decided to start Ms. A on treatment with lorazepam, 0.5 mg b.i.d., due to her inability to tolerate a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor. Our patient had never experienced hair loss before and had no history of endocrine illness. Her past medical history was significant for cervical cancer treated with radiation therapy in 1978 without recurrence. The SSRIs fluoxetine,1,2 sertra-line,3 and paroxetine4 have been reported to cause hair loss in a very small minority of patients. To our knowledge, there has been only 1 report of hair loss associated with venlafaxine therapy,5 and ours is the first report of hair loss with both fluoxetine and venlafaxine.