What’s black and white and red all over? My hair on prescription drugs, apparently. I am on Quetiapine, an antipsychotic medicine that controls the occasional but acute fears I’ve had since experiencing psychosis 10 years ago. I’ve tried all manner of meds but settled on this one due to its lack of side effects for me – or so I thought. Two years into quite liking what Quetiapine did for my brain, my hair shed and my icy cool brunette tint warmed to a patchy red tinge suddenly and significantly in the sun. So not what the doctor ordered. I had a rat girl summer, scurrying away from UV rays, ragged ponytail trailing behind me. When it comes to hair maintenance, it appears that a close bond with your hairstylist won’t cut it alone. In this modern, medicated world, it’s the chemistry that counts.
“I have a large clientele of women with issues from medication and menopause that have impacted their lives and confidence,” says Zoë Irwin, creative director at John Frieda Salons. “My WhatsApp is full of pictures of small bundles of hair that they find in the shower and message to me for virtual therapy. Colours lose their vibrancy and in turn this makes the client feel flat too.” Inspecting my colour, Shari Reynolds, a senior colourist at George Northwood with more than 40 years experience, and my go-to for the past year, is certainly surprised that it’s lightened so much since my last appointment.
“It seems to be very sensitive to the sun,” she tells me, running her fingers through my unasked-for auburn locks, before quietly inquiring if I’m on any prescription medicine, followed by: “How long for?” My response of “a couple of years” apparently made precise sense, timeline-wise. When I investigate matters further with Zoë Passam, senior consultant trichologist at Philip Kingsley, she concurs: “Based on an average rate of hair growth of one to 1.5 centimetres per month, it would take some months to a couple years for a medication to impact the lengths of the hair. If someone has only recently started a medication, it’s impossible this could impact response to hair colour in the short term.”
But in the longer term, that’s when you might – and I did – start to see changes. “Medication build-up on hair can often distort the desired end result,” agrees hairstylist Adam Reed, who observed a huge spike in colour reactions after the pandemic. “There are things like L’Oréal Professionnel Metal Detox that help remove the build-up. I use it on clients who have voiced their concerns – usually due to hormone replacement therapy – where you can really see a difference in the hair. I tend to keep all medication queries totally individual because medications affect everyone differently.”
I squint for “haphazard hair colour” in the small print on the leaflet that comes with my Quetiapine. Nothing, but online I find: “a psychotropic agent belonging to a chemical class, dibenzothiazepine derivatives, is photosensitive and photolabile”. Is this why my colour misbehaved? “Yes, it’s most certainly an adverse photo-allergic reaction,” affirms Dr Michalis Kyratsous, a consultant psychiatrist, clarifying that, “Drug-induced photosensitivity is the development of either photo-toxic or photo-allergic reactions due to being on medication and exposure to ultraviolet or visible light.”
“The body’s response to medication in each individual shows up differently,” says Sibi Bolan, another creative colour consultant and balayage specialist in my little black book. “While being discreet, I do ask clients about any surgeries or big medical issues that have impacted their body or hair with significant changes.” Bolan tunes out certain ingredients accordingly. “For my brunettes, I use ammonia-free/lead-free products and much lower levels of peroxide.”
I find an online hair forum. Lots of people, it seems, are questioning a whole heap of nervous-system medicines that they fear may be affecting hair colour, including Diazepam, Sertraline, Venlafaxine, Methylphenidate and Duloxetine. “There are hundreds of pharmaceutical agents that potentially pose a risk of this,” says Kyratsous, noting that it’s impossible to pinpoint the exact drugs to put on a beauty treatment watchlist. “The major limitation is the lack of strong and replicable scientific evidence. Most evidence comes from individual case reports, but the largest category of drugs implicated in photosensitive reactions is indeed nervous system medications, such as antipsychotics, antidepressants and anxiolytics.”
The crux is that for people like me, with chronic health and mental health conditions, we already feel bad, hence our need to take medication. When these interfere with the things we do for continued self-care to try to make ourselves feel good, it’s a cruel Catch 22. I am also half the mane I used to be, with thinning hair another thing I have to contend with. Reynolds says the growing extent of this specific symptom more widely post-pandemic blows her mind. “We would chat about it professionally around once a year and now it’s every second conversation in my chair, especially after Covid. It is important to let clients know they are not the only one and eliminate stigma.”
And it’s not just hair. Aesthetic treatments can hit differently too. “Any medication or supplement that makes your skin sensitive to light will make your skin react much more strongly to the light produced by lasers and IPL,” says facialist and laser expert Debbie Thomas. “The most common types of light-sensitising medications are antibiotics and antidepressants. Not all of them are an issue so check carefully if your particular one is. Also St John’s wort, a herbal mood booster, causes light sensitivity too.”
The contraindications start stacking up. So what of Botox? Now I am on this path, I need to know. I ask skin expert Dr Anne Mendelovici. “For Botox, it’s not recommended to have treatment when taking aminoglycoside antibiotics, anticholinesterase medicines or muscle relaxants as there is a risk these will increase the effect of muscle relaxation,” she explains. “It’s preferable to choose a different antibiotic or postpone injections. It’s also important for patients taking anticoagulants to notify the doctor ahead of treatment, as they will need to be extra careful before and after injections, to avoid bleeding, bruising or hematoma. When possible, the patient will be asked to stop anticoagulant medication prior to treatment.” To this day, she says, there is no contraindication in taking medication and doing filler.
Mendelovici highlights an obvious but important fact: before proceeding with any aesthetic treatment it’s compulsory to fill in a form listing all relevant medical history, any previous conditions, medication being taken and allergies. Should this not be a prerequisite for hair colour too? For the moment, it’s all in the hands of a compassionate colourist. “Do I ask about medication? Not in the first appointment, as it could be perceived as invasive,” admits Irwin.
“I do however immediately talk about blood tests and the impact of iron levels and thyroid and oestrogen [on hair quality]. I would never ask directly about antidepressants, but I do use myself as an example to bring these things in. You see, one person takes medication and it has no effect on her hair. [For] the next person, there’s a dramatic effect. The essential takeaway is before spending lots of money, if you are on medication, find out what you personally need by doing your homework and working with your hairstylist to get it right. That’s the way beauty science should go. It’s never a one-size-fits-all.”
