A selective serotonin reuptake inhibitor (SSRI) is generally used for initial treatment of major depressive disorder (MDD). A serotonin-norepinephrine reuptake inhibitor (SNRI), bupropion (Wellbutrin SR, and others), and mirtazapine (Remeron, and others) are reasonable alternatives. Improvement in symptoms can occur within the first two weeks of treatment with these drugs, but a substantial benefit may not be achieved for 4-8 weeks.1
The FDA has approved ritlecitinib (Litfulo – Pfizer), an oral JAK and TEC kinase family inhibitor, for treatment of severe alopecia areata in patients ≥12 years old. Ritlecitinib is the second oral drug to be approved in the US for treatment of severe alopecia areata; baricitinib (Olumiant), a JAK inhibitor, is approved only for use in adults.1
THE DISORDER — Alopecia areata, which affects about 700,000 persons in the US,2 is an autoimmune disorder characterized by rapid hair loss that results in patches of baldness on the scalp, eyebrows, and eyelashes and sometimes total hair loss.
STANDARD TREATMENT — Topical immunotherapy with diphenylcyclopropenone or squaric acid dibutyl ester is generally the first-line treatment for severe alopecia areata.3 Intralesional or topical corticosteroids …