Hair Loss as a Rare Side Effect of Mood Stabilizers
Introduction:
Antiseizure medications (ASMs) such as Depakote (valproate), Tegretol (carbamazepine), and Lamotrigine are commonly prescribed not only for epilepsy but also for managing various mental health disorders, particularly bipolar disorder. These medications play a critical role as mood stabilizers, helping to control the mood swings associated with bipolar disorder. However, while effective, they can have side effects, including the rare but distressing condition of hair loss or alopecia. This blog explores the insights from the article "Antiseizure Medication-Induced Alopecia: A Literature Review'' published in Medicines 2023, which discusses the psychiatric applications of ASMs and the management strategies for alopecia. Understanding both the therapeutic benefits and the potential side effects is essential for patients and healthcare providers to make informed decisions about the use of these medications in mental health treatment plans.
Psychiatric Applications of ASMs:
ASMs such as Valproate, Carbamazepine, and Lamotrigine are frequently used in the treatment of bipolar disorder and other mood disorders due to their mood-stabilizing properties. These medications help to manage mood swings and are particularly effective in the prevention of manic episodes. The article reviews various ASMs and notes their efficacy in both seizure control and mood stabilization, which is vital for patients with dual diagnosis of epilepsy and a mood disorder.
Side Effects and Management:
While effective, ASMs come with potential side effects, notably alopecia (hair loss), which can significantly impact a patient's quality of life and adherence to medication. The article provides a comprehensive review of alopecia associated with ASM use, noting that it is generally non-scarring and reversible with medication adjustment. This section is particularly important for psychiatrists to consider, as the cosmetic side effects can affect the mental health of patients.
Zinc and Selenium in Treatment:
Zinc and selenium supplementation has been identified as a beneficial treatment for ASM-induced alopecia. The article suggests that these supplements can help mitigate hair loss associated with drug therapy.
To manage valproate-induced hair loss, a combination of zinc, selenium, and biotin is often recommended, with clinical observations suggesting this mix can be effective in preventing recurrence of hair loss, allowing patients to continue using valproate. The Recommended Dietary Allowance (RDA) for selenium is 55 mcg/day for adults, with the Tolerable Upper Intake Level set at 400 mcg/day, exceeding this can lead to side effects including hair and nail brittleness and hair loss.
When recommending selenium supplements, it's crucial to consider the total daily intake from all sources, including diet and multivitamins, to avoid surpassing the safe upper limit. Among the selenium supplements tested and approved by ConsumerLab, NOW® 200 mcg and Nature's Way® 200 mcg are reliable choices, both offering 200 mcg per dose and suitable for vegetarians.
Implications for Practice at Philadelphia Integrative Psychiatry:
The insights from this research are instrumental for Dr. David Danish and his team at Philadelphia Integrative Psychiatry in making informed decisions about prescribing ASMs as mood stabilizers. Understanding the side effects, even extremely rare side effects, is important for how we handle dual role of these medications not only in seizure control but also in mood stabilization allows for a more holistic approach to patient care. Additionally, being aware of manageable side effects like alopecia ensures that treatment plans remain patient-centered, improving adherence and overall treatment outcomes.
For further reading, access the full article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10301592/pdf/medicines-10-00035.pdf
