Antidepressants and hair loss
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Antidepressants and Hair Loss: Overview and Risk Factors
Hair loss, or alopecia, is a recognized but generally rare side effect of many antidepressant medications. Both older and newer classes of antidepressants—including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs)—have been associated with hair loss in some patients, though the risk varies by drug and individual susceptibility 125.
Comparative Risk of Hair Loss Among Antidepressants
A large retrospective cohort study found that bupropion carries a higher risk of hair loss compared to other commonly prescribed antidepressants. In this study, all other antidepressants, including SSRIs and SNRIs, had a lower risk of hair loss than bupropion, with fluoxetine and paroxetine showing the lowest risk among the drugs studied . Fluvoxamine was associated with a slightly higher risk than other SSRIs, but still lower than bupropion .
Case Reports: Specific Antidepressants and Hair Loss
SSRIs and Hair Loss
- Fluoxetine: Several case reports document hair loss in patients taking fluoxetine, with symptoms typically resolving after discontinuation of the drug 2610. Both male and female patients have been affected, and the hair loss often appears within weeks of starting treatment 610.
- Citalopram: Hair loss has also been reported with citalopram, another SSRI. In one case, hair loss was linked to an increased dose, and the symptom resolved after intervention .
- Escitalopram: Hair loss is a rare but possible side effect of escitalopram, with only a few cases reported in the literature .
- Paroxetine: There are rare reports of hair loss with paroxetine, which resolved after stopping the medication and did not recur when the patient switched to another SSRI, sertraline .
- Fluvoxamine: Hair loss has been observed in patients taking fluvoxamine, with symptoms improving after discontinuation .
SNRIs and Other Antidepressants
- Venlafaxine: Although more commonly associated with tricyclic antidepressants, hair loss has also been reported with SNRIs like venlafaxine. In one case, hair loss began after two months of treatment and resolved after stopping the drug .
- Tricyclic Antidepressants and Others: Hair loss has been reported with several tricyclic antidepressants and other agents, though these cases are rare 25.
Mechanism and Reversibility of Antidepressant-Induced Hair Loss
The exact mechanism by which antidepressants cause hair loss is not fully understood, but it is thought to involve disruption of the hair follicle growth cycle, particularly the telogen (resting) phase 57. Most reports indicate that hair loss is reversible, with regrowth occurring after the medication is discontinued or the dose is reduced 57910.
Clinical Implications and Patient Management
Although hair loss is an uncommon side effect, it can have significant psychological and social impacts, potentially leading to noncompliance with antidepressant therapy 245. Clinicians should monitor for this side effect, especially in patients who report new or worsening hair loss after starting or increasing the dose of an antidepressant. In most cases, switching to another antidepressant or reducing the dose can resolve the issue 5910.
Conclusion
Hair loss is a rare but recognized side effect of many antidepressants, including SSRIs, SNRIs, and tricyclics. Bupropion appears to carry a higher risk compared to other antidepressants, while paroxetine and fluoxetine have among the lowest risks. The condition is usually reversible upon discontinuation or dose adjustment. Clinicians should be aware of this potential side effect and discuss it with patients, as it may affect treatment adherence and quality of life 125678910.
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