Q:  Questions re. Lamictal & Hair Loss

Dr. Phelps,

I have been on lamictal for several years and have not experienced any hair loss until recently. I have been taking propecia for 2 years because hair loss runs in my family. I didn't have any visible signs of hair loss two years when i started propecia. my hair was thick and full.

But recently, within the last couple of months, I have experienced rapid hair loss, especially at the frontal hair line.

I have also been taking a lot of fish oil for the last couple of months as well, about 6 grams/day. any connection to hair loss?

Is it possible that lamictal is causing the hair loss even if its 4 yrs later? this doesn't make sense to me. If so, would zinc and selenium work if it is being caused by lamictal, as it does for depakote?

Does it work for lithium induced hair loss, as I am thinking about switching meds.

Could it be from a low thyroid?

finally, I have also expericed a lot of skin propblems that have been treated with a anti-fungal meds. can this tie in with a thyroid condition as well?

I have asked a lot of questions here. sorry. I appreciate your efforts and want to thank you in advance for putting together this site as it has answered many of my questions.

Don
                             

Dear Don --

Those are all reasonable and understandable questions and they all follow from trying to figure out what to do in the face of losing hair while on lamotrigine (Lamictal) . Unfortunately, I am probably not going to be able to answer any of them very satisfactorily -- except one.

First, could the hair loss start after years of taking lamotrigine. As you point out, this would be quite unusual in terms of how medications like this produce side effects. Generally, if one is going to see a problem, one would see it soon after getting to a given dose. Obviously, as you are aware, that is the simplest way to make a causal connection between the two. However, one might speculate that some mechanism just took a long time to trigger and that we should not be too quick to let lamotrigine off the hook. In that case, there would probably be no way to figure this out other then tapering off the lamotrigine (which of course you would not consider doing except in detailed discussion with your psychiatrist, I am sure).

Could fish oil have any connection to this? I surfed around a little bit and did not find anything particularly illuminating. Somehow my mind has filed a connection between fish oil and improved hair health, but I'm not sure where that came from. I found some herbal types on the Internet advocating it as well but no evidence was cited so this really means rather little, as does my recollection.

Would zinc and selenium help? Unfortunately, here again, the real answer is "I don't know". You would probably get better advice or at least something to go on from a dermatologist or a hair specialist somewhere. Lithium does not cause hair loss very often, independent from the effect on thyroid, in my experience.

But of all the things you ask here, the one I can address firmly is the next one: low thyroid levels can indeed be associated with hair loss, at least a thinning, and because checking thyroid levels is so easy, that certainly would be worth considering.

As for the anti-fungal medications, you would have to pursue the same determined investigation -- not just whether this has been observed in their clinical trials, but whether it has been reported at all in some fashion that would suggest a causal connection (e.g. case reports). Good luck with the continued search.

Dr. Phelps