Hair Loss With Lamotrigine (Lamictal) Treatment

Months ago someone asked me, on Bipolar World's "Ask-a-doc" page, about whether lamotrigine causes hair loss. At the time I had trouble finding much to go on, to answer that question. It is listed (at the less than 1% level) in the prescribing information from the manufacturer.

But now comes a very clear report of the phenomenon in a respected journal. (Hillemacher) This augments the numerous reports one can find online (e.g. Googling lamotrigine hair loss). It does seem clear that lamotrigine can be associated with substantial hair loss.

The same vitamins which have been recommended for valproate (Depakote)-associated hair loss (as that medication is well-known to cause this problem) were suggested informally by one person who felt they had helped: selenium and zinc, which can be found together in the (expensive) vitamin called Centrum Silver.

International Meeting Over; Back to Light and Dark!

After two weeks in London and Scotland, which included attending the International Society for Bipolar Disorders meeting in Edinburgh, I'm back to the computer. Interesting how life looks without one. Same as it used to look, frankly. Can't put one's thoughts immediately into print, is the big difference. So now I have a backlog of writing to put up.

I started with several changes/updates on my website. The page on Light and Dark: Therapy Implications is changing almost weekly with new information sent by readers. A collaboration is developing with the John Carroll University light engineers whose website, www.lowbluelights.com, presents their products for nearly eliminating exposure to blue light at night. (The reason for the emphasis on blue light is explained in my Light and Dark essay above.) They are research scientists, primarily, and so are already interested in helping get the idea of blue-blocking technology for bipolar disorder into testing.

I've advocated trying their lights and glasses even without such testing because the downside -- cost and risk -- is almost nil and the potential benefit is great. You'd have to be skeptical about that advocacy if I was selling the glasses, but I'm not: I have no connection with the sale of any such products.

Recent changes include a study the JCU researchers' website lists, which -- to my great surprise -- shows that this idea of blocking blue light at night has already been tested! Well, it was tested to the extent of showing that using a pair of glasses, such as the JCU team's website sells, does indeed change the sleep chemical melatonin, just as we would hope were this whole idea to really be true.^Kayumov This study showed that wearing blue-blocking lenses allowed evening melatonin production to begin just when it should, and continue normally, when the person wearing them was exposed to moderately bright light at intervals between 8 pm and 8 am. In contrast, those who were randomly assigned to wear a clear lensed pair of glasses instead had substantial changes in their melatonin production. Since the onset of your own melatonin production is supposed to help get you to sleep, interfering with it means interfering with one of the main signals your body is using to know that it's time to be asleep.

The next step will be to see if people with bipolar disorder have improved sleep (easier to get to sleep, especially) if they wear the blue-blocking lenses. Several readers are already trying this and attempting to "serve as their own controls" by wearing the lenses for two weeks, then not wearing them, then wearing them again, charting information about their sleep all the while.

If you're going to do this yourself, make sure to include that step about charting. For an amazing tool to gather such information using your computer (if you're on it every day -- otherwise this would be a bit of a hassle), see www.chronorecord.org. Go to "Get Started", select the patient option; and when you get to the "referred by" box, enter Dr. Jim Phelps.

Yellow lenses at night for sleep: Not Such a Strange Idea

A previous post here referred readers to information on blue light as the particular form of light which affects our biological clock timing. That's why the newest light boxes, for light treatment of SAD (seasonal affective disorder), use just blue light.

But there's a little known flip-side to that story, about avoiding too much light at night, to preserve normal biological clock timing. I've written about this in an essay about "Dark Therapy", an interesting idea, but not well-tested.

Combining the blue-light story for SAD treatment with the Dark Therapy idea leads to a very odd -- but safe and cheap! -- idea for improving sleep. This would be most useful for people who have difficulty falling asleep because their mind is still wide awake; or people who have "rapid-cycling" bipolar disorder, which the dark-therapy research (such as we have to go on) suggests that quality darkness might be a "mood stabilizer" for them.

The combination of these two research threads suggests this: blocking exposure to blue light at night might be sufficient, rather than blocking all light as in the Dark Therapy approach, to allow easier falling off to sleep, or perhaps even gain the "mood stabilizer" effect of being in complete darkness. That's because of the selectivity of the biological clock for blue light, a story told in more detail on my page about why blue light is the one that matters in this business.

Blocking blue light is pretty easy -- and cheap -- because special glasses, with yellow lenses, for this purpose have already been developed, for other medical conditions . What I did not think had been done yet, in research, was to study the effect of those glasses on sleep.

But yesterday I found, courtesy of a reader (RH), that this approach has already been studied! A research team has already shown that using yellow-lensed glasses at night preserves normal biological clock timing even during late night light exposure. (Kayumov)

All that remains to be shown is that these lenses might actually help people fall asleep, by using them earlier in the evening, for people who can't get their mind to shut off when they're ready to try to go to sleep. Or that using these lenses might act like a "mood stabilizer" for people with rapid cycling bipolar disorder. That will be exciting research to watch for.

In the meantime I can imagine that some people are going to try it anyway, figuring that $40 for a pair of these glasses is worth a go (there are less expensive ones, but they block less blue light). If it seemed to work, it's pretty cheap -- and it's hard to imagine a risk that might go along with this, except looking rather geeky in the privacy of your own home at night. But hey, Jonathon, another reader, is already trying them at work! He works nights and is trying them to see if he can get to sleep easier after his shift when he uses the glasses. So far? He thinks they might be working but is going to conduct some on-off trials: 2 weeks with the glasses, 2 weeks without, to see if he can tell the difference. He's kindly sharing his results with me as he goes along. I'll post them.

For more on all this, try my essay on Light and Dark in Bipolar Disorder.