Q:  Lamictal & Hair Loss

Hello, my question deals with a bipolar medication...Lamictal.  I have taking this medicine and am experiencing significant hair loss.  I had no idea this could happen or else I never would have started taking it.  I have immediately stopped taking it since my hair has been falling out.  My question is...is this type of hair loss permanent or will my hair start growing back again?  I would be so grateful for an answer to this question.  As a male, who had a thick head of hair before taking this drug, I can only pray that my mistake has not doomed me to a life of baldness!

Thanks
 

Dear F-

As you have learned from your experience, and perhaps from looking at the list of known side effects for this medication, this reaction is known to occur with Lamictal. Is extremely uncommon. I have not seen it in any of my patients, but someone else wrote to ask about it and when I looked it up I saw that this had indeed been reported. All that is to say that when we doctors tell patients about bad things that can happen when they take the medication, we generally list those problems which are well-known and common. We do not generally talk about things which are uncommon, like this reaction.

You might think that we should. You might think that if we were to disclose all the bad things that have been clearly associated with the medication, people would be more hesitant to use them, as you say that you would have been. This is a tricky step in prescribing the medication. In theory, the doctor is supposed to know about these uncommon reactions, and make a judgment as to how many of them to disclose to the patient. In practice, I am confident that other doctors are very much like me: we do not try to memorize the list of uncommon side effects. We try to master of the list of significant risks and routinely disclose those.

We are also supposed to make a judgment about the total "risk-benefit ratio" for our particular patient. In other words, we are supposed to make a decision about how much of the "bad stuff" a given patient needs to hear. I know, this sounds like "paternalistic medicine", but it is a recognized part of our job. For some patients, I routinely suggest that they consult other resources including the Internet to learn more about the potential risks, before they begin a medication, knowing that they are likely to do so. Overall, the patient and the doctor should collaborate in evaluating risk. However, for some patients, they may be so concerned about risk that they might avoid using medications which could be of very substantial benefit. In those cases, the doctor may then use his or her judgment to create a proper balance between impressions of risk versus benefit. This is part of our job. Sometimes, the skewed impression of risk is even part of the illness we are trying to treat, although I try to be very careful about this assumption.

Now, as for whether your hair is going to come back: we might extrapolate from experience with Depakote, where this side effect is common (and where I do routinely disclose it, though sometimes not to men, as it is the women who are generally far more concerned about this, and because generally the degree of loss is relatively subtle, so that women are much more likely to be able to notice it than men). With Depakote, there are definitely comes back. Some women have noted that it seems more curly than before the Depakote-loss effect. As for lamotrigine, whether this hair loss will respond in similar fashion, I do not know for certain. I suspect your hair will come back just as with Depakote, but cannot guarantee that. I hope that turns out to be the case.

Dr. Phelps