Expert Q&A

Isabelle Vallerand, PhD, on Depression as a Risk Factor for Alopecia Areata

While it is well-known that alopecia areata (AA) is associated with an increased risk of major depressive disorder (MDD), new research suggests this association may actually be bidirectional.

A new study published in JAMA Dermatology found that the presence of AA was associated with a 34% higher risk of subsequent MDD, which is consistent with previous scientific evidence. Less expectedly, however, the presence of MDD was found to be associated with a 90% higher risk of subsequent AA, with antidepressant use as a confounder.

Consultant360 spoke with lead author Isabelle Vallerand, PhD, about the key clinical takeaways of her study and the protective potential of antidepressants in preventing AA.

Isabelle Vallerand, PhD, is an epidemiologist and medical student at the Cumming School of Medicine’s Department of Community Health Sciences at the University of Calgary in Alberta, Canada.

Consultant360: Were you surprised by the magnitude of the bidirectional association between AA and MDD?

Dr Vallerand: While it has been well-known that patients with AA have a higher risk of depression, we were surprised to find that the magnitude of this association was higher in the opposite direction as well, where depression is a major risk factor for developing AA in the first place. Most people have heard the expression “so stressed that your hair is falling out,” but this had never been explored scientifically until now.

New evidence suggesting that depression exerts a large influence on autoimmune disease pathogenesis is starting to accumulate. Certainly, identifying that depression increases the risk of AA by 90% is higher than expected and really highlights an important link between mental health and dermatologic conditions.

C360: Given the findings from your study, what role could antidepressants play for AA prevention in patients with MDD?

Dr Vallerand: We identified that the incidence of AA was significantly lower among individuals prescribed antidepressants, which suggests that indeed antidepressants likely have a role in preventing the development of AA in the first place. However, it remains unclear what the mechanisms are that explain this protective effect, and whether specific antidepressant agents are more beneficial than others. Certainly, additional research will be needed to understand the exact role antidepressants may play in AA. 

C360: What would you say are the key clinical takeaways from your study?

Dr Vallerand: Clinicians should be aware that patients with AA are at significant risk of developing depression, but also that depression can in itself be a major driver for AA development, perhaps through shared inflammatory pathways. Patients with depression who are treated with antidepressants appear to have a decreased risk of developing AA, but it is not yet clear whether this represents the effect of treated depression, or if antidepressants have a direct pharmacologic action towards AA.

C360: What are the next steps in your research?

Dr Vallerand: Within the field of psychodermatology, it will be interesting to study the effect of depression on other dermatologic diseases and to study what role antidepressants may have in dermatologic clinical practice.

—Christina Vogt


Vallerand IA, Lewinson RT, Parsons LM, et al. Assessment of a bidirectional association between major depressive disorder and alopecia areata [Published online January 16, 2019]. JAMA Dermatol. doi:10.1001/jamadermatol.2018.4398.