Antidepressants in alopecia areata: Could they help the hair if depression is also present?

Is there a role for antidepressants in alopecia areata patients?

Antidepressants may not only benefit some patients with depression but may have an anti-inflammatory effects as well. inflammation is increasingly understood to have some type of role in the mechanisms that lead to depression. It has been proposed that the anti-inflammatory actions of antidepressants maybe relevant to their anti-depressive effects. Decreases in TNF -alpha levels and increases in IL-10 levels may be among the effects observed with antidepressants.

Studies of Antidepressants in Alopecia Areata

To date, there have been three controlled trials of antidepressants in pateins with alopecia and several case reports. These include studies of using the following antidepressants:

1) Imipramine 75 mg daily

2) Paroxetine 20 mg daily

3) Citalopram 20 mg daily

4) Trimipramine 100 mg daily

Three Controlled Antidepressant Trials of Note

Three controlled trials have reported beneficial effects of antidepressants in treating alopecia areata. Patients with alopecia areata that were part of these studies had either anxiety or a depressive disorder.

STUDY 1: Perini et al, 1994

Perini and colleauges conducted one of the earliest studies looking at the potential benefits of antidepressants. Here they studied the tricyclic antidepressant antidepressant imipramine. The authors conducted a placebo-controlled study with imipramine 75 mg once daily as the sole therapy for alopecia areata. At 6 months, hair regrowth was reported in 5 out of 7 patients treated with imipramine, with no regrowth noted in the placebo group of 6 patients.

STUDY 2: Cipriani et al, 2001

In 2001, a small randomized controlled study was conducted by Cipriani and colleagues. The study involved a total of 13 patients with alopecia areata who were randomized to receive either paroxetine 20 mg (8 patients) or placebo (5 patients). The authors reported a better outcome with paroxetine than placebo.

Unlike other studies this study also includes more severe and resistant types of AA: alopecia totalis in 3 patients and alopecia universalis in one patient. Paroxetine was given for 3 months, with a follow-up at 4 and 6 months after treatment was discontinued. Complete regrowth of hair was observed in 2 patients treated with paroxetine, and 4 patients showed partial regrowth.. In comparison, only one patient from the placebo group had an almost complete regrowth of hair.

STUDY 3: Abedini and colleauges, 2014

In a 2014 study by Abedini et al. 60 individuals with recent onset AA were treated with triamcinolone injections in alopecic patches, and one half of these (i.e. 30 indivdiuals) were randomized to also receive the open-label supplement of citalopram 20 mg orally once daily. At 6 months of treatment there was significantly more hair regrowth, as measured by reduced mean diameter of the alopecic patch, in the citalopram patients compared with the triamcinolone injection only patients. Citalopram was then stopped at the 6 month mark, and patients were reassessed after another 6 months. Relapse of AA was noted in 20% of patients who had previously received citalopram compared with 66.7% of patients who had only received triamcinolone injections.

Reference

Abedini H, Farshi S, Mirabzadeh A, Keshavarz S. Antidepressant effects of citalopram on treatment of alopecia areata inpatients with major depressive disorder. J Dermatol Treatm 2014; 25: 153–155.

Cipriani R, Perini GI, Rampinelli S. Paroxetine in alopecia areata. Inter J Dermatol 2001; 40: 600–601

Perini G, Zara M, Cipriani R, Carraro C, Preti A, Gava F, et al. Imipramine in alopecia areata. A double-blind, placebo-controlled study. Psychother Psychosom 1994; 61: 195–198. 56.

Ricciardi A, Ruberto A, Garcia-Hernandez MJ, Kotzalidis GD, Trevisi M, Persechino S, et al. Alopecia areata with comorbid depression: early resolution with combined paroxetine- triamcinolone treatment. J Eur Acad Dermatol Venereol 2006; 20: 1000–1001.

Ruiz-Doblado S, Carrizosa A, Garcia-Hernandez MJ, Rodrigu-ez-Pichardo A. Selective serotonin re-uptake inhibitors (SS-RIs) and alopecia areata. Int J Dermatol 1999; 38: 798–799.