Article written by Doctor Massimo Gabellini.
Humor Disorders and Hair Loss: A Complex Relationship
Mood disorders currently represent a rather widespread condition in the population, and younger and younger patients are affected.
Regardless of the severity and specific clinical manifestations, mood disorders, from simple states of mind, can develop into full-fledged psychiatric disorders that require targeted therapeutic interventions and specialized management.
Alopecia and Psychological Impact: How Hair Loss Affects Self-Perception
Problems related to hair loss are frequently considered as true psychosomatic diseases: indeed, it is undeniable that there is a close relationship between hair and the psychic sphere and there are several studies in the literature associating hair loss and mood, and often the boundary between cause and effect remains difficult to decipher.
Alopecia can in fact be responsible for psychological issues, just as the latter can sometimes promote hair loss; if we consider that some drugs used in the treatment of baldness count among their side effects precisely the appearance of mood disorders, here is that the picture is completed and further complicated, often making it really difficult to diagnose and manage the issue.
From the onset, hair loss can lead to an alteration of self-perception, especially in those conditions in which the fall occurs abruptly, as in alopecia areata, particularly in the total or universal forms, the evolution of which justifies depressed mood states and/or avoidant-type behaviors. Such behaviors are also very common in the affected person with Androgenetic Alopecia (AGA), especially if this condition occurs at a young age.
Many patients with AGA exhibit borderline traits of personality disorders that often result in true conditions of Body Dysmorphism, where the patient tends to view his or her “defect” in an exaggerated manner.
The Need for a Collaborative Therapeutic Approach in the Treatment of Alopecia
The treatment of alopecia must in some cases involve a collaborative management between different professional figures: when dermatological therapy is not sufficient to contain the problem and hair loss is followed by significant psychological distress, resorting to the figure of the psychiatric specialist or psychologist assumes an important value in the overall management of the problem.
Depression and Hair Loss: The Role of Stress in the Complication of the Hair Problem
In many cases depressive disorders are a real consequence of hair loss and conversely act with a maintenance mechanism of the trichological problem, which we know to be very sensitive to changes in mood states: thus a vicious cycle of hair loss and depression is created, where the boundaries between cause and effect are lost.
Any stressogenic condition can be responsible for altering the normal physiological processes of the Pilosebaceous Unit, resulting in defects in hair protein synthesis.
Cortisol, strongly released during stress and anxiety conditions, in fact causes metabolic alterations that result in increased Prostaglandins, particularly PGE2, which are responsible for alterations in the production of keratin, one of the main constituents, of hair. Adrenaline and Noradrenaline levels are also increased under such conditions, and their action at the follicular level alters protein production.
Side Effects of Finasteride: A Review of its Role in Mood Disorders
Finasteride, one of the most widely used drugs in the treatment of AGA, is often called into question in the determinism of mood disorders and therefore deserves a closer look.
In 2012, Dr. Irwing was among the first to introduce a new “alert” for finsteride treatment in AGA, noting in an article published in the Journal of Clinical Psychiatry, a high incidence of depression in patients taking that drug, with persistence of side effects even after discontinuation. It was the FDA that had “mood disorders” added to the package insert of finasteride as an infrequent adverse event.
In fact, recent studies have uncovered a correlation between use of the drug and altered levels of Neurosteroids. Among these, one neurotransmitter in particular with regulatory functions, Allopregnanolone, found in plasma and cerebrospinal fluid, is a potent modulator of GABA-A receptors , which has anti-stress, anxiolytic, and antidepressant properties and is able to intervene in the metabolization of some drugs used in the treatment of mood disorders.
Therapy with 5 alpha reductase inhibitors can significantly reduce neurosteroid biosynthesis and on the basis of these considerations it seems likely to partially justify some side effects of finasteride: Anxiety, reduced sexual desire and impotence, up to depression, may be a consequence of the reduction of endogenous production of Allopregnanolone, whose biosynthesis is 5-alpha-Reductase dependent (although predominantly type I, so it would be a partial inhibition).
Certainly such evaluations invite us to reconsider the importance of a controlled and predominantly low-dose administration of the drug, to patients who must necessarily be informed of the possible, albeit rare side effects and contraindications related to its use.
Conclusion: The Importance of Not Neglecting Mood Disorders in the Treatment of Hair Loss
In conclusion, it is essential never to underestimate the “mood disorders” that may accompany hair loss, because they may be a consequence of the trichological condition, but also of the established therapy, not forgetting that they in turn may be the cause of hair loss or possible worsening.
What is referred to in trichological circles as “Psychogenic Alopecia” (Field) has boundaries that actually extend to any condition associated with hair loss.
The therapeutic management of the trichological problem always has important repercussions on the psychological sphere and in some cases cannot disregard the collaboration between different professional figures.