Could Depression be the Cause of My Hair Loss?

Hair Loss Can Cause Depression and Depression can Cause Hair Loss and Things that Cause Depression Can also Cause Hair loss

I’ve selected this question below for this week’s question of the week. It allows us to review some of the important concepts underlying depression and hair loss.

Question

I am a 41 year old female. I just received a formal diagnosis of depression. I have been battling hair loss for 2 years. Could my hair loss be due to this depression?

Answer

Thanks for the question. I’ve selected it because this is a pretty complex question and so has many important things for us to review together.

Depression is common in the population and so is hair loss. This makes understanding depression and hair loss both important to explore. For some patients, the two issues are separate, in others the two are closely related.

About 9 % of women and 5 % of men have depression. Depression and anxiety go together and about 50 % of those diagnosed with depression also have anxiety. Data from the US National Health Interview Survey confirms just how common depression actually is. In 2019, surveyed people in the general public were asked about depressive symptoms in the prior 2 weeks. 2.8% of adults reported severe symptoms of depression, 4.2% reported moderate symptoms, and 11.5% reported mild symptoms The percentage of adults who experienced any symptoms of depression was highest among those aged 18–29 (21.0%), followed by those aged 45–64 (18.4%) and 65 and over (18.4%), and lastly, by those aged 30–44 (16.8%). Surveyed female respondents were more likely than male respondents to experience mild, moderate, or severe symptoms of depression.

How is the diagnosis of depression made?

The diagnosis of depression must be made by a practitioner who understands how to make the diagnosis. Making a diagnosis of depression is more than just sadness. There are several depressive disorders that a specialist can make. A fully history and physical examination is needed and blood tests are needed as well to rule out other medical conditions that can cause depression.

Blood tests are really important for anyone with depression. We want to rule out deficiencies and abnormalities that can also cause depression. Blood tests for CBC, TSH, ferritin, AM cortisol, VDRL/RPR, vitamin B12, zinc, CRP, 25 hydroxy-vitamin D, testosterone, free testosterone, magnesium, folate, zinc, glucose, hemoglobin A1c should all be carefully considered in any patient with depression. For women, consideration should be given also to estradiol testing if the patient is not on hormone related medications. Testing for a celiac panel and ANA may be warranted if the history and physical examination show these tests are also warranted.

The DSM 5 Criteria for Depression

The DSM-5 outlines the criteria to make a diagnosis of depression. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines a major depressive episode as at least two weeks of a depressed mood or loss of interest or pleasure in almost all activities, as well as at least five other symptoms, such as:

1. Depressed mood most of the day, nearly every day.

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.

4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).

5. Fatigue or loss of energy nearly every day.

6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.

7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.

8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.

What are practical ways to “screen” and “diagnose” for depression?

To “screen” for depression, physicians often use the two question PHQ2 first. This simple questionnaire asks 1) whether or not the patient has had little interest or pleasure in doing things and 2) whether the patient has been feeling down, depressed or hopeless. If the patient scores 3 or more, it’s considered a positive screen. From there, the physician moves on to using the PHQ 9 (Patient Health Questionnaire 9). The PHQ9 helps the physician determine if the patient meets the criteria for a depressive disorder and then to evaluate the severity of the disorder. In terms of depression severity, a score of 0-4 indicates no depression, a score of 5-9 indicates mild depression, a score of 10-14 indicates moderate depression, a score of 15-19 is moderately severe depression and a score of 20-27 is severe.

Back to the Question

With that basic information, we can now come back to your question.

Many of the blood test abnormalities that can be associated with depression that cause hair loss. So it’s absolutely essential that you speak to your doctors to make sure you have had the appropriate blood tests done. The full list of tests that any person needs can only be determined from listening to a patient’s story and performing a full examination. There is no one magic list for everyone. As I reviewed above, there are basic tests that everyone should have. In case you missed it, these were CBC, TSH, ferritin, AM cortisol, VDRL/RPR, vitamin B12, zinc, CRP, 25 hydroxy-vitamin D, testosterone, free testosterone, magnesium, folate, zinc, glucose, hemoglobin A1c and possibly estradiol, ANA, and a celiac panel.

Low iron, thyroid problems, endocrine issues, syphilis, inflammatory disease and low zinc can all be associated with hair loss as can abnormalities of testosterone or estrogen.

If both your depression and hair loss are the result of a thyroid disorder and you properly treat your thyroid disorder - your depression and hair loss could potentially improve.

Hair loss can cause depression in some individuals and there is no doubt that emotional issues of various kinds can cause or worsen hair loss. There is a very close connection sometimes between the two.

I also need to mention that hair loss among women age 41 is not uncommon and so I would need more information to know if your hair loss is in any way related to depression. 15 % of women your age will have androgenetic alopecia (female pattern hair loss) and so this needs to be evaluated by your doctors. Other issues like alopecia areata, scarring alopecia and other causes of telogen effluvium all need to be ruled out. In some cases, it may turn out that a patient’s depression and hair loss are related but in some cases they will both be happening independently.

I hope this helps and thank you again for submitting your question.