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Jul 27, 2020
5 min read

Which antidepressant causes the most hair loss?

60% of Americans who are taking antidepressant medication have been on it for two or more years, with 14% having taken the medication for at least ten years. Many antidepressants have been linked to insomnia, nausea, and dizziness, but hair loss is usually a rare side effect.

Disclaimer

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.

If you’re reading this, you might be wondering how it’s possible that a medication intended to help with depression can actually end up doing some harm. You’re not alone, and learning about the relationship between antidepressants and hair loss may help you make decisions that could stop or even reverse this troubling issue. 

Research from the National Center for Health Statistics shows that the rate of antidepressant use among teens and adults in the United States increased by almost 400% between 1988–1994 and 2005–2008 (Pratt, 2011).

The same report found that more than 60% of Americans who are taking antidepressant medication have been on it for two or more years, with 14% having taken the medication for at least ten years (Pratt, 2011). 

Judging by this information, it seems safe to say that these medications are here to stay. And similar to any medical decision that might have a long-term impact on your life, it’s important to make informed choices when it comes to choosing an antidepressant.

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What to know about antidepressants

An antidepressant is a type of drug used to help treat depression. Of the five major classes of antidepressants, selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are the most commonly prescribed for first-line treatment. SSRIs help to alleviate symptoms by blocking the reabsorption of serotonin in the brain, while SNRIs block the reabsorption of both serotonin and norepinephrine.

Examples of SSRIs include:

Examples of SNRIs include:

Monoamine oxidase inhibitors (MAOIs)

Prevent the breakdown of norepinephrine, serotonin, and dopamine in the brain and other parts of the body. Notable MAOIs include phenelzine (brand name Nardil), selegiline (brand name Emsam), and tranylcypromine (brand name Parnate).

Tricyclic antidepressants (TCAs)

Are another class of drugs used to treat depression by blocking the reabsorption of serotonin and norepinephrine in the brain. Imipramine (brand name Tofranil) and amitriptyline (brand name Elavil) are two common types, and TCAs, in general, tend to have more side effects. 

The final category of antidepressants is called atypical antidepressants; each medication influences serotonin, norepinephrine, and dopamine levels in unique ways. We’ll learn more about one of the most commonly prescribed medications, bupropion (brand name Wellbutrin; see Important Safety Information), later in the article.

Do antidepressants cause hair loss?

Many antidepressants have been linked to insomnia, nausea, and dizziness, but hair loss is usually a rare side effect.

A team of researchers in New Zealand conducted a study to better understand how a group of 180 long-term antidepressant users felt about the experience. The five most commonly selected adverse effects were withdrawal effects (73.5%), sexual difficulties (71.8%), weight gain (65.3%), emotional numbness (64.5%), and failure to orgasm (64.5%). Hair loss didn’t make the list (Cartwright, 2016).

A 2018 comparative retrospective cohort study examined a large U.S. health claims database from 2006 to 2014 to review the risk of hair loss among various antidepressants (Etminan, 2018). Among one million people on ten different antidepressants, researchers found an increased risk of alopecia among those taking bupropion (Wellbutrin) compared with SSRIs and SNRIs.

Compared with bupropion (an atypical antidepressant), all other antidepressants had a lower risk of hair loss, with fluoxetine (brand name Prozac) and paroxetine (brand name Paxil) showing the lowest risk. Conversely, fluvoxamine (brand name Luvox), had the highest risk compared with Wellbutrin (Etminan, 2018).

Telogen effluvium = temporary hair loss

Antidepressants typically cause a type of hair loss called telogen effluvium. It is one of two types of drug-induced hair loss and can develop as a possible side effect of many widely used medications and supplements. The second type of drug-induced hair loss is called anagen effluvium.

Telogen effluvium occurs when hair follicles are in the resting phase and fall out too early. It’s more common than anagen effluvium, which involves actively growing hair and affects not only hair on the scalp, but eyebrows, eyelashes, and other body hairs as well.

Normally, around 85% of a person’s hair follicles are in the actively growing (anagen) phase, and the remaining 15% are resting hair in the telogen phase. During telogen effluvium, roles can reverse with as many as 70% of the anagen hairs can be precipitated into telogen (Cherry Chang, 2019).

The resting hairs are attached to the hair follicles on the scalp. Then, once the medication triggers the telogen effluvium, the new hairs will push out the resting hairs. This will result in an increase in hair loss within 2–3 months. The good news is that telogen effluvium usually occurs without any scarring and is typically reversible.

How and when to discuss your concerns with your healthcare provider

Prior to starting a new antidepressant medication, it’s helpful to have a list of questions prepared for your healthcare provider. As it relates to hair loss, these might include:

  • What side effects could the new medication have?
  • Will the new medication have any effect on hair growth?
  • If so, is there an alternative medication that doesn’t lead to hair loss?

You can also research the side effects of any drugs you’re taking on RXList.com.

If you’re already taking the medication when you begin to notice signs of hair loss or hair thinning, it’s just as important to bring your questions to your provider.

They’ll likely start off by taking a comprehensive medical history, which will include all symptoms and hair loss timeline. There are countless potential reasons for hair loss—genetics, diet, illness, stress—so it’s important to differentiate drug-induced telogen effluvium from other diagnoses.

If the hair loss is believed to be linked to an antidepressant, your provider may choose to reduce or eliminate the drug for several months in order to observe any regrowth. The caveat here is that this should always be done under a healthcare provider’s order and occur gradually as opposed to cold turkey. Abruptly discontinuing an antidepressant medication can lead to something called antidepressant discontinuation syndrome—a temporary flu-like withdrawal reaction to ending a medication (Warner, 2006).

Once people stop taking an alopecia-inducing medication, they’ll typically see a change within six months. At this point, or maybe even sooner, your healthcare provider will have a better understanding of the growth patterns and whether additional treatment is necessary.

In the meantime, consider these alternative methods for coping with hair loss during treatment for depression.

  • Non-medical options like wigs and scarves can be used to camouflage hair loss. Some people, mostly men, may even shave their heads.
  • Cosmetic treatments, such as Toppik, can make thinning hair less noticeable. Toppik comes in powder form and is patted over thin spots as purely a cosmetic solution for hair loss.

In conclusion

With more than half of the U.S. population taking antidepressant medication, it’s important to understand any and all side effects. For many people, these drugs make a significant difference in their mental and behavioral health, and although hair loss is a distressing symptom, these concerns should be balanced against one another.

The good news is that telogen effluvium typically occurs without any scarring and is often reversible. It’s possible to work with your healthcare provider to find an alternative antidepressant medication or explore other solutions for treating and managing hair loss.

References

  1. Cartwright, C., Gibson, K., Read, J., Cowan, O., & Dehar, T. (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/#:~:text=The%20five%20most%20commonly%20selected,a%20moderate%20or%20severe%20level.
  2. Cherry Chang, F. L. (2019). Telogen effluvium. Retrieved from https://dermnetnz.org/topics/telogen-effluvium/ 
  3. Etminan, M., Sodhi, M., Procyshyn, R. M., Guo, M., & Carleton, B. C. (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/
  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, No. 76. Hyattsville, MD: National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db76.htm
  5. Warner, C. H., Bobo, W., Warner, C., Reid, S., & Rachal, J. (2006). Antidepressant Discontinuation Syndrome. American Family Physician, 74(3):449-456. Retrieved from https://www.aafp.org/afp/2006/0801/p449.html