TLDR Valproic acid increases the risk of hair loss more than other drugs, especially in migraine patients, and lamotrigine may be a safer alternative.
The systematic review and meta-analysis by Xueping Wang and colleagues from 2019 analyzed the risk of alopecia in patients treated with valproic acid (VPA) compared to other drugs. The study included 25 articles with sample sizes ranging from 28 to 480 patients, totaling 1587 patients treated with VPA. It found that VPA therapy was associated with a significantly higher risk of hair loss, with an overall incidence of 11%. The risk was higher compared to all other drugs (odds ratio [OR] 5.02), other antiepileptic drugs (AEDs) (OR 4.82), and non-AEDs (OR 5.84). The increased risk was more frequently reported in patients with migraine than those with epilepsy, and the risk did not depend on the dose or treatment duration. The study concluded that VPA has a higher risk of inducing alopecia and suggested that lamotrigine (LTG) may be a preferable alternative due to its lower risk of hair loss. The authors recommended larger studies to confirm these findings and to investigate the dose-dependency of the risk.View this study on doi.org →
Hair loss from mood stabilizers is common but can be managed without stopping the medication.