Alopecia Areata and Anxiety and Depression

Understandably, sudden hair loss can be extremely distressing, whether it’s bald patches on the scalp or total baldness that develops from head to toe. This is what happens in the case of Alopecia Areata and its more expansive iterations, Alopecia Totalis and Alopecia Universalis, autoimmune disorders which disrupt the hair growth cycle.

Therefore, it is perhaps unsurprising to learn that various studies have found people affected by any form of Alopecia Areata are more susceptible to mental health issues such as anxiety and depression.

A study carried out by researchers from Massachusetts General Hospital in Boston, USA, and published in the Journal of the American Academy of Dermatology on 1st June 2019, is the latest to explore these links.

Higher risk of anxiety and depression for people with Alopecia Areata

Teams from the hospital’s Dermatology and Neurology departments worked together to analyse existing literature surrounding the association between all forms of Alopecia Areata, anxiety, and depression.

After reviewing a total of eight clinical studies, it was concluded that patients with Alopecia Areata are ‘at a higher risk of both anxiety and depression’.

As the study author writes, ‘A total of 8 studies that included 6,010 patients with AA and 20,961 control patients were included in the quantitative analysis. These included 4 cross-sectional studies and 4 case-control studies. Analysis of these studies demonstrated a positive association with anxiety (pooled OR, 2.50; 95% CI, 1.54-4.06) and depression (pooled OR, 2.71; 95% CI, 1.52-4.82).

Healthcare professionals must be cognisant of this higher risk and consider routine assessment of these conditions and referral to appropriate providers when indicated.’

…and vice versa

In addition to studies backing the link between people with Alopecia Areata developing psychological conditions, there are also research findings claiming those with existing mental health problems may have a higher chance of developing Alopecia Areata, or one of its phenotypes.

Men and women who experience PTSD or intense stress have been shown to more prone to a later diagnosis of autoimmune hairloss. Furthermore, a pre-existing depression diagnosis has been shown to increase the risk of developing Alopecia Areata, Totalis or Universalis by up to 90 per cent.

A 2019 mortality study showed that adults with Alopecia Areata had a higher risk of dying from smoking-related diseases, such as lung cancer. As those who are stressed, depressed or anxious are believed to smoke more as a form of ‘self-medication’, this could be a relevant factor in the study’s outcome, providing another reason dealing with the psychological aspects of hair loss is so important.

Where patchy hair loss of the scalp-only is concerned, in the majority of cases this will resolve itself naturally within 12 months, though Alopecia Areata treatment may be used to help accelerate the hair regrowth process. The bald spots may come back in the future, as this condition is known to recur, but if or when this may happen is unpredictable.

For the more extensive forms, there are currently no significantly effective treatment options available, though many trials are underway and it is hoped that clinically-proven Alopecia Totalis and Universalis hair loss treatments, authorized by relevant medical regulators, should start to become available from around 2021.

About Brandon Ross MD