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Do antidepressants cause hair loss


Diffuse Hair Loss Induced by Sertraline Use

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  • Case Rep Psychiatry
  • v.2015; 2015
  • PMC4589582

Case Rep Psychiatry. 2015; 2015: 703453.

Published online 2015 Sep 17. doi: 10.1155/2015/703453

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Hair loss is a rare side effect of psychotropic drugs. The most related drug class with this side effect is the mood stabilizers. Studies reporting the sertraline-induced alopecia are limited in number. Sertraline is a potent antidepressant which inhibits the serotonin reuptake from the presynaptic terminals selectively. The reason for hair loss could not be elucidated completely. Psychotropic drugs are usually considered to lead to hair loss through influencing the telogen phase of hair follicle. This paper reports a 21-year-old male with diffuse hair loss induced by sertraline use and improved by quitting the drug. To the best of our knowledge, there are no other case reports on sertraline-induced alopecia within 2 weeks.

Hair loss is among the side effects of psychotropic drugs [1]. The most related drug class with this side effect is the mood stabilizers [2]. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed antidepressants for the treatments of major depressive disorder, obsessive compulsive disorder, panic disorder, generalized anxiety disorder, posttraumatic stress disorder, and many other psychiatric disorders [3]. There are a limited number of studies in the literature regarding the SSRI-induced alopecia.

Drug-induced hair loss generally diffuses with no scars and improves after quitting the drug. When drug-induced hair loss is suspected in a patient, other reasons for hair loss including hyperthyroidism, hypothyroidism, trichotillomania, hormonal disorders resulting from the hypothalamic-pituitary-gonadal axis disorders as well as iron, copper, and zinc deficiency, menopause, oral contraceptives, and use of other drugs (anticoagulants, anticonvulsants, antihypertensive agents, nonsteroidal anti-inflammatory drugs, and antiulcer drugs) should be considered in the differential diagnosis [4].

As far as we know, there are no other case reports on the sertraline-induced alopecia. Our study aimed to contribute to the literature and to the physicians in clinical practice.

A 21-year-old, unmarried, high school graduate male patient (E. C. K.) was admitted to our psychiatry outpatient clinic with insomnia, loss of appetite, weight loss, memory impairment, reluctance, malaise, and fatigue. Medical history of the patient revealed no hair loss, no alcohol-cigarette-substance use, and no medical or psychiatric disorders. In the psychiatric examination, patient was conscious, cooperative, and fully oriented with decreased self-care, depressed mood, and impaired vegetative symptoms (initial insomnia and a reduction in appetite and libido). The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was applied to the patient; no symptoms other than depression were detected [5, 6]. The total score on Beck Depression Inventory was 41. The patient was hospitalized with the diagnosis of major depressive disorder. Sertraline was started at the dose of 50 mg/day. Fifteen days after starting the sertraline treatment, a consultation was requested from dermatology clinic for active hair loss. Thyroid, liver, and kidney function tests as well as levels of vitamin B12, iron and folate, iron binding capacity, serum electrolytes (Na, K, Ca, Cl, and Mg), sedimentation rate, complete urinalysis, total testosterone, DHEA-S, and zinc and copper levels were analysed. Although the examination and treatment processes were not completed, the patient was discharged on his own request. Sertraline was recommended to be used at the dose of 50 mg/day. The patient was told to visit the outpatient clinic a week later. At the outpatients' control visit, hair loss was found to be progressive. Depressive symptoms were found to be decreased with a score of 22 on the Beck Depression Inventory. Since no other cause was found to be responsible for the hair loss, sertraline treatment was stopped and hair loss disappeared in 2 weeks. Another antidepressant drug was prescribed and the patient had no hair loss complaints at his visit 1 month later.

Psychiatric disorders are among the most prevalent diseases [7, 8]. The SSRIs are prescribed by both psychiatrists and nonpsychiatrist clinicians. There are a limited number of studies in the literature reporting SSRIs-induced alopecia. In the study by Spigset [9], dermatological side effects constituted 11.4% of the SSRIs-induced side effects; dermatological side effects were more common with fluoxetine use; and the most common dermatological side effect was rash.

Sertraline differs from other 5-HT reuptake inhibitors in its chemical structure and is a naphthylamine derivative [3]. Sertraline has SSRI a more potent inhibitor effect of dopamine reuptake compared to the inhibition of the norepinephrine reuptake [3]. Sertraline-induced side effects are similar to those induced by the other SSRIs and include headache, dizziness, tremor, sweating, sleep disturbances, dry mouth, gastrointestinal disorders, and sexual dysfunction [3].

Many medications can cause hair loss, although the mechanism has not been fully understood [1]. Psychotropic drugs are considered to cause hair loss by affecting particularly the telogen phase of the hair production [10]. Side effects of these drugs affecting hair are not only limited to the hair loss. They have been suggested to be changing the structure and the colour of the hair as well [11]. Drug-induced hair loss usually occurs within the first 3 months of the treatment [12]. In addition, other antidepressant medications may cause telogen hair loss too. Fluoxetine is the most common SSRI causing hair loss [13]. In a review on this issue, hair loss was found to be present after fluoxetine use in 725 cases and in 6, 7, and only 3 cases using fluvoxamine, paroxetine, and sertraline, respectively [10].

When a patient complains of hair loss due to starting a drug, it is important to be sure that this is a pathological hair loss. Gentle hair pull test can be used to objectively determine the hair loss [14, 15]. Gentle hair pull test is a simple test that can be applied by any physician. In order to gain accurate results patients should avoid washing their hair starting from 5 days before the test. A lock of hair containing an amount of about 50–60 hair roots is held with the first three fingers and pulled gently toward the end. Hairs extracted are counted. If more than 10% of the hair lock (>6) is extracted the test is accepted to be positive and means an active hair loss is present. If it is below 6, it is accepted as the normal physiological hair loss [14, 15]. Our case was hospitalized and this test was applied following the rules and active hair loss was detected.

It is difficult to decide whether hair loss is related to the drug use since there are no available specific methods for a definite diagnosis. For diagnosing drug-induced hair loss, other possible etiologic causes should be excluded and the hair loss and drug starting time or dose changes should be relevant. A reliable way to verify the diagnosis of drug-induced hair loss is the finding of hair loss reduction or disappearance when the drug is stopped and the reappearance of the hair loss reappeared with restarting the drug [11]. However, patients usually do not accept the restart of the same drug [11, 16]. In the present case, sertraline was stopped after the hair loss was observed and was not restarted. The hair loss was considered to be induced by sertraline use, because there was a temporal relationship between hair loss and drug starting time; hair loss disappeared when the drug was stopped and other etiologic causes of hair loss were excluded. Naranjo et al.'s Adverse Drug Reaction Probability Scale evaluates the side effects of the drugs. In this scale, a score of 9 and over, 5–8, 1–4, and 0 is described as certain, likely, potential, and suspicious, respectively [17]. Our case had 9 points and thus hair loss was considered as a certain side effect.

In some case reports, hair loss has been reported to be present after a month of sertraline use [18, 19], while in our case hair loss was seen within the first 2 weeks. This might be related to hospitalizing the patient at the beginning of the treatment. In this way, it was possible to monitor the patient closely and side effects were detected earlier than the patients under the follow-up in the outpatient clinic.

Although the patients in the previous case reports were predominantly female [18, 19], the patient in our case report was male. This might be due to the fact that females take care of their physical appearance; thus they may recognize the physical changes earlier and seek medical help immediately.

Because SSRIs-induced hair loss is rare, clinicians may disregard this side effect. Moreover, many patients may not recognize the hair loss as a side effect of the drug. Patients may not be giving feedback. Because there are a limited number of studies in the literature, the exact prevalence of sertraline-induced hair loss can be detected more clearly by carrying out large-scale studies and increasing feedback levels.

This study was performed without any financial or other contractual agreements that may cause conflict of interests.

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Articles from Case Reports in Psychiatry are provided here courtesy of Hindawi Limited

Which Antidepressant Causes the Most Hair Loss?

  1. Do antidepressants cause hair loss?
  2. Is hair loss from antidepressants permanent?
  3. What to know about antidepressants
  4. When to see a healthcare provider

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

The millions of Americans who take antidepressants are probably familiar with common side effects like weight gain and sexual dysfunction. But you may not be aware that some antidepressants also cause hair loss. 

Although hair loss is a distressing symptom, these concerns should be balanced against one another. Learning about antidepressants and hair loss may help you make informed choices regarding navigating depression treatment options. 

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As the name implies, antidepressants are medications used to treat depression. Side effects linked to these drugs include insomnia, nausea, and dizziness, but hair loss (alopecia) is a rare reaction.

Research on long-term antidepressant use found the following to be the most commonly reported adverse effects (Cartwright, 2016): 

  • Sexual difficulties
  • Weight gain 
  • Emotional numbness 
  • Failure to orgasm 

As you can see, hair loss did not make the list. However, a research review comparing hair loss among various antidepressants found people taking bupropion (brand name Wellbutrin; see Important Safety Information) had a higher risk of hair loss compared to others like selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) (Etminan, 2018).

Other antidepressants had a lower risk of hair loss with fluoxetine (brand name Prozac; see Important Safety Information) and paroxetine (brand name Paxil, Brisdelle; see Important Safety Information) showing the lowest risk. Among the typical antidepressants, fluvoxamine (brand name Luvox) had the highest risk, but not as high as bupropion (Etminan, 2018).

Antidepressants can cause telogen effluvium, a type of temporary hair loss triggered by things like stress and medication. Telogen effluvium occurs when hair follicles in the resting phase fall out too early. 

Normally, around 85% of a person’s hair follicles are in the actively growing (anagen) phase. The remaining 15% are resting hairs in what’s called the telogen phase. But if you experience telogen effluvium, those roles reverse; this launches up to 70% of hairs into the telogen phase, which is when new hairs push out the resting ones (Hughes, 2021).

The good news is that telogen effluvium usually occurs without any scarring and is typically reversible.

SSRIs: everything you need to know

Antidepressant medications Last updated: May 17, 2021 9 min read

Of the major classes of antidepressants, SSRIs and SNRIs are the first-line treatment. SSRIs alleviate symptoms by blocking the reabsorption of serotonin in the brain. SNRIs block the reabsorption of serotonin and norepinephrine.

Examples of SSRIs include:

  • Sertraline (brand name Zoloft; see Important Safety Information)
  • Paroxetine 
  • Fluoxetine 
  • Escitalopram (brand name Lexapro; see Important Safety Information)
  • Fluvoxamine 
  • Vilazodone (brand name Viibryd)
  • Citalopram (brand name Celexa)

Examples of SNRIs include:

  • Duloxetine (brand name Cymbalta; see Important Safety Information)
  • Venlafaxine (brand name Effexor; see Important Safety Information)
  • Levomilnacipran (brand name Fetzima)
  • Desvenlafaxine (brand name Pristiq)
  • Milnacipran (brand name Savella)

Other types of medications include monoamine oxidase inhibitors, tricyclic antidepressants, and atypical antidepressants like bupropion.

Before starting a new antidepressant, it’s helpful to have a list of questions prepared. As it relates to hair loss, you might want to ask a healthcare professional questions like: 

  • What side effects could the new medication have?
  • Will the new medication impact hair growth?
  • If so, is there an alternative drug that doesn’t cause hair loss?

If you’re taking antidepressant medication and notice signs of hair loss or thinning, it’s just as important to talk with your provider—don’t just stop taking these drugs on your own. There are countless reasons for hair loss (like genetics, diet, illness, and stress) so it’s important to differentiate drug-induced telogen effluvium from other issues.

Your provider may reduce or eliminate the drug for several months to see how your hair responds. The caveat here is that this should always be done gradually as opposed to cold turkey. Abruptly stopping these medications can lead to what’s called antidepressant discontinuation syndrome—a temporary flu-like withdrawal reaction to ending a medication (Warner, 2006).  

Antidepressants: types, side effects, uses, and risks

Antidepressant medications Last updated: May 26, 2021 10 min read

Once people stop taking the drug, they’ll typically see hair regrowth within six months. At this point (or maybe even sooner), your healthcare provider will better understand your hair growth patterns and if additional treatment is necessary. 

Research shows that more than 60% of Americans taking antidepressants have been on them for two or more years. Roughly 14% have used the medication for at least 10 years (Pratt, 2011). Judging by this information, it seems safe to say that these medications are here to stay, so it’s important to understand all side effects. 

The good news is that if loss of hair occurs, it usually only lasts a few months and is reversible. You can work with your healthcare provider to find an alternative medication or explore other solutions for treating and managing hair loss from antidepressant use.

  1. Cartwright, C., Gibson, K., Read, J., et al. (2016). Long-term antidepressant use: patient perspectives of benefits and adverse effects. Patient Preference and Adherence, 10, 1401–1407. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970636/
  2. Etminan, M., Sodhi, M., Procyshyn, R. M., et al. (2018). Risk of hair loss with different antidepressants: a comparative retrospective cohort study. International Clinical Psychopharmacology, 33(1), 44–48. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28763345/
  3. Hughes, E. C. & Saleh, D. (2021). Telogen effluvium. StatPearls. Retrieved April 1, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK430848/
  4. Pratt, L. A., Brody, D. J., & Gu, Q. (2011). Antidepressant use in persons aged 12 and over: United States, 2005–2008. NCHS Data Brief, 76. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db76.htm
  5. Warner, C. H., Bobo, W., Warner, C., et al. (2006). Antidepressant Discontinuation Syndrome. American Family Physician, 74(3), 449–456. Retrieved from https://www.aafp.org/pubs/afp/issues/2006/0801/p449.html

    Hair Loss Depression - Dr. Acar

    The Cosmedica Team

    We are an international team committed to providing the best hair transplant services on the market and to informing and educating people around the world about hair loss and its treatments.

    Article content

    A threat called hair loss

    Thinning hair , thinning hair and baldness are very common human scalp problems. These states are associated with hair loss , otherwise known as alopecia. Hair loss is a condition in which excessive hair loss occurs. Hair loss can be observed in men and women, as well as in representatives of different age groups.

    For many years, hair loss experts have associated this threat with hormonal problems , symptoms of old age or other physical illnesses. However, there is new evidence that mental health problems can not only cause hair loss, but also be the result of people losing their hair. nine0005

    Cosmedica - Dr. Acar , a leading hair clinic, is committed to helping people overcome the symptoms of hair loss and factors such as depression that lead to hair loss . Here are important details about how depression causes hair loss and treatments to follow when treating depression from hair loss.

    Common types of hair loss in men and women

    Hair loss can have different effects on individuals. This is because different types of hair loss can affect different people. These types of hair loss can be either permanent or temporary.

    In general, The American Academy of Dermatology recognizes the following most common types of hair loss.

    Alopecia areata: This type of hair loss is most common in young people. Alopecia areata usually causes people with this condition to lose their hair in clumps.

    Androgenetic alopecia: This type of hair loss is also called male pattern baldness. This condition causes the hair to fall out in the middle in an "M" shape.

    Telogen effluvium: Telogen effluvium occurs mainly due to stress and is characterized by large amounts of hair loss. Hair loss in this disease begins at the resting stage of the hair growth cycle.

    Trichotillomania: this condition is known as hair-pulling disorder and usually results in a constant and irresistible impulse to pull hair from various parts of the body. nine0005

    Trichorrhexis nodosa: Unlike other conditions that cause hair to fall off the scalp, trichorrhexis nodosum simply breaks off at weak points.

    Relationship between depression and hair loss

    Patients with mental illnesses always experience far-reaching consequences from the conditions they suffer from. But more recently, hair loss has been linked to suffering from anxiety and depression. Although there are no direct studies that prove that depression causes hair loss, there are several types of studies that show how depression can cause the conditions that lead to hair loss. nine0005

    One such condition is stress . With increased levels of stress, the likelihood of thinning hair and hair loss can increase. Hair loss can also be the result of stress associated with childbirth or depression caused by unwanted life events or problems such as death, ill health, or problems at work.

    Chronic use of birth control pills can also lead to some level of depression. This, in turn, leads to hormonal imbalance - a strong factor responsible for hair loss. Similarly, people who use antidepressants usually experience hair loss as a side effect of taking them.

    Hair loss depression treatment

    If you are suffering from depression associated with hair loss it is important to take steps to restore healthy hair. One of the best methods is to take care of the health issues that usually lead to depression. nine0005

    If the hair does not grow back, a hair transplant can be considered. Hair transplantation involves taking hair from a donor area of ​​the body and transplanting it to areas of the scalp where the hair has fallen out.

    Hair transplant is a common procedure at Cosmedica and is recommended as a permanent solution to hair loss, especially caused by depression or hereditary factors.

    Final Thoughts on Depression in Hair Loss nine0012

    Although there are several drug treatments for hair loss depression , not all forms of treatment are appropriate due to side effects. That's why you need a specialist to help you get through recovery. Fortunately, Cosmedica does just that. Contact us today to access high quality treatments that will improve your health growth.

    Do you have any questions? nine0012

    If you have any questions about hair transplant in Turkey , Dr. Levent Acar and his team will be happy to help you. Get a free, no-obligation hair consultation today.

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    Stress causes hair loss, but not immediately

    Recently, the number of patients with alopecia has increased several times. Almost all of them say: experienced stress. First because of covid, now because of the political situation. Stress triggers a cascade of adverse reactions in the body, and sensitive hair follicles react to it so sharply that 3-4 months after the stress, the hair literally climbs in bunches. Why is this happening and what to do? nine0137

    Constantly, about 85-90% of the hair on our head is actively growing (anagen phase), and the rest is at rest (telogen phase). Under the influence of stress, hair (from 30 to 70%) abruptly enters the telogen stage prematurely, and then falls out. In this case, we are talking about telogen effluvium. But hair loss does not occur immediately, but after about 100 days, when we no longer think about the traumatic situation. Often patients are perplexed: how is it that the stress was in January, and the hair began to fall out only in April. The fact is that the phase of rest and loss on average lasts almost 4 months. During this time, the hair root gradually moves to the surface of the skin and falls out. And now, we already see tufts of hair on the comb, clothes, in the bathroom and on the pillow. nine0005

    How does stress affect hair?

    There are several theories about exactly how stress affects hair follicles, causing hair loss in large numbers.

    Blood microcirculation is disturbed

    It is believed that during stress, blood flow goes to vital organs that ensure the integrity of the body. With this distribution of blood, the hair follicles, shrouded in a network of capillaries, lack nutrients, so they enter the resting phase prematurely. nine0005

    Hormonal fluctuations occur

    Under stress, there is an intense release of cortisol into the blood, it reduces the level of testosterone and increases the level of dihydrotestosterone in the tissues, which can lead to the launch of androgenetic alopecia - female-type hair loss (thinning, thinning) or male-type ( baldness in the fronto-temporal and parietal zone, on the top of the head). Hair loss eventually subsides, but the volume does not return. Patients complain of bald patches, gaps, expansion of the central parting. In addition, stress can lead to problems with the thyroid gland - the appearance of autoimmune thyroiditis, exacerbation of hyperthyroidism and hypothyroidism, which can also be one of the reasons why hair stops growing. nine0005

    Autoimmune diseases develop

    Against the background of stress, nest-shaped hair loss often occurs when the body attacks its own follicles: one or more foci ranging in size from a pea to a five-ruble coin or more appear on the scalp in a short time. The episode can be single, sometimes it closes on its own, and new foci may appear and merge with each other. The disease is not fully understood, but stress plays a big role here. In this case, only a trichologist will help. nine0005

    Depletion occurs

    Any noticeable imbalance of vitamins and minerals causes the follicles to go dormant. During stress, there is a large consumption of trace elements and vitamins, especially B vitamins, which are important not only for the functioning of the nervous system, but also for hair. These vitamins affect the absorption of iron, without which latent iron deficiency anemia can develop, and this is often the cause of alopecia. In addition, some antidepressants, which are often prescribed by psychiatrists to stabilize the emotional state, have hair loss as a side effect. nine0005

    What to do about it?

    First, check the level of glucose in the blood, the amount of total protein, cholesterol, thyroid hormones, take tests to determine the level of vitamins D, C, B6, B9, B12, as well as trace elements - iron, zinc, copper, magnesium, selenium, iodine. The deficit needs to be filled, and at the same time to establish a sleep and wakefulness regimen, a diet, and reduce emotional stress.

    To cleanse the scalp, leave your usual shampoo according to the type of scalp - oily, dry or normal. In pharmacies, you can buy products for hair loss, as well as connect peeling for the scalp 1-2 times a week. It may contain fruit acids, salicylic or glycolic acid - they have anti-inflammatory and antioxidant effects, stimulate collagen synthesis.

    Learn more