8/12/2019 Will antidepressants exacerbate my hair loss?

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WILL ANTIDEPRESSANTS EXACERBATE MY HAIR

LOSS?
July 02, 2018

Question

QUESTION: Will antidepressants exacerbate my hair loss? Is is possible to get the treatment I
need without making things worse, without inciting another TE?

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Answer
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Thanks for submitting this question. This is an important question and a common concern
among many people. It's actually quite an involved question. We'll begin with the basics and
then move into some important points for consideration. The main point that individuals
should be aware of is that the risk of shedding with antidepressants is a lot lower than most
would think. It doesn't mean there's no risk, but it is far more likely that a person will NOT get
shedding from their anti-depressant than actually experience shedding.

Antidepressants are the third most common prescription medication in North America (behind
cardiovascular drugs and anti-cholesterol drugs). Recent surveys estimate that one out of
every six North Americans use some sort of psychiatric medication. About 12 % of these
drugs are antidepressants. Studies by the National Center for Health Statistics (NCHS) have
showed that the rate of antidepressant use in the United States among teens and adults
increased by almost 400% between 1988–1994 and 2005–2008. Nearly 1 in 10 individuals in
the United States use antidepressants. The age group with the highest use was women 40-50
where nearly 1 in 4 women between 40 and 50 taken antidepressants. Statistics in other
countries around the world indicate that antidepressant use is on the rise. Antidepressant use
in the UK is similar to the United States where 1 in 11 individuals used antidepressants last
year. Citalopram (Celexa) and Sertraline (Zoloft) were the most commonly prescribed
antidepressants in the United States.

There are several classes of anti-depressants including selective serotonin reuptake inhibitors
(SSRI's), serotonin and norepinephrine reuptake inhibitors (SNRI's), tricyclic antidepressants
(TCA's), Wellbutrin and monoamine oxidase inhibitors (MAOI's).

Let's take a look at what is known about the risk of shedding (telogen effluvium) with these
medications.

Selective serotonin reuptake inhibitors (SSRIs)

Common SSRI's include fluoxetine (Prozac), citalopram (Celexa), sertraline (Zoloft),

paroxetine (Paxil) and escitalopram (Lexapro). Litt's Drug eruption Manual estimates that
shedding with SSRI's occurs in less than 1 in every 100 users.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Venlafaxine (Effexor) and duloxetine (Cymbalta) are common SNRI-based anti-

depressants. Litt's Drug eruption Manual estimates that shedding with SNRI's occurs in less
than 1 in every 100 users.

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Wellbutrin HAIR CLINIC
Wellbutrin is an anti-depressant that affects dopamine. Litt's Drug eruption Manual estimates
that shedding with Wellbutrin occurs in less than 1 in every 100 users.

Tricyclic antidepressants (TCAs)

Tricyclic antidepressants include a wide variety of drugs. Some preferentially inhibit the
reuptake of serotonin (such as clomipramine, imipramine). Others preferentially inhibit the
reuptake of norepinephrine (such desipramine and nortriptyline). Others yet are fairly
balanced reuptake inhibitors of serotonin and norepinephrine (such as amitriptyline). Litt's
Drug eruption Manual estimates that shedding with TCA's occurs in less than 1 in every 100
users.

Monoamine oxidase inhibitors (MAOIs)

MAOI's used in depression include Isocarboxazid (Marlin), Phenelzine (Nardil), Selegiline

(Emsam), Tranylcypromine (Parnate). The exact incidence of telogen effluvium with these
drugs is unclear, but MAOI's are generally thought to have the lowest shedding risk of all
antidepressants (well under 1:100).

Shedding with Antidepressants - Key Considerations

When a patient comes in to see me with worries that their antidepressant is causing hair loss,
there are several things that need to be consider. I'll address each in turn

Possibility 1. The antidepressant is truly causing a "telogen effluvium" type

hair loss

Typically, if an anti-depressant is truly implicated in a person's hair loss, the shedding starts in
4-8 weeks after starting the anti-depressant. It's a diffuse type shedding, meaning that the
shedding occurs all over the scalp equally. Patients who experience shedding 6-8 months
after starting the antidepressant or notice more hair loss in one area of the scalp than another
probably do not have antidepressant related hair loss. Some other cause is implicated.

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Possibility 2. A telogen effluvium is present but it's not due to the

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One must always rule out other causes of excessive hair shedding in anyone who feels they
are losing more hair on a daily basis. Causes of shedding include high stress, low iron,
thyroid problems, medications, dieting and internal illness. A patient who has depression from
a thread problem may be shedding from the thyroid issue rather than the antidepressant they
were started on. A patient who has depression from lupus may be shedding from the
autoimmune disease itself rather than the antidepressant they were started on. A careful
history is essential. It is also mandatory that anyone with depression have blood tests as part
of their work up for depression. All patients with depression should have already had blood
tests. Similarly, it is mandatory that anyone with excessive hair shedding also have blood tests
as part of their work up for excessive shedding. Many of the tests for excessive shedding are
similar to the tests they may have had as part of their depression evaluation. The relevant hair
related tests include hemoglobin, thyroid studies (TSH), ferritin (iron storage). Other tests may
also be relevant depending on the person's specific history.

Possibility 3. The patient has a hair condition that is different than telogen
effluvium but is a close mimicker

A variety of conditions can mimic (i.e. closely resemble) "telogen effluvium" including
androgenetic alopecia and diffuse alopecia areata. These need to be carefully ruled out by a
dermatologist. Similarly, other scalp issues which can be worsened by depression such as
seborrheic dermatitis can increase the amount of daily shedding a person experiences.

Summary

Anti-depressants can most certainly cause hair loss. However, when a patient says to me "I
think my anti-depressant is causing my hair loss" - more often than not it's actually due to
another cause. Individuals with depression who have experienced previous episodes of
telogen effluvium should speak with their physicians about whether the risks and benefits of
both antidepressants and hair shedding. Individuals who are considering antidepressants
can weigh the less than 1 % chance of developing hair shedding from the drug against
the potential life altering benefits of being treated properly for depression.

Reference

1) Litt ‘s Drug Eruption Reference Manual 14th edition 2008

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2) Moore TJ, et al. Adult Utilization of Psychiatric Drugs and Differences by Sex, Age, and
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Race.JAMA Intern Med. 2017.

3) Laura A. Pratt et al. Antidepressant Use in Persons Aged 12 and Over: United States,
2005–2008. NCHS Data Brief No. 76, October 2011.
https://www.cdc.gov/nchs/data/databriefs/db76.htm (accessed Jul 2 2018)

Comments (4) Newest First Subscribe via e-mail

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H 8 months ago

I have had severe shedding (all over) from Parnate. It is definitely the Parnate as my
physicians and dermatologist have ruled out other causes. The severe shedding
caused me once to stop the Parnate out of total frustration, and it ceased immediately.
However, with TRD, I’ve been on every other protocol including ECT and Parnate is
truly my “miracle drug” for severe anhedonic depression. I’ve tried the other MAOIs and
they are not effective. Is there ANYTHING I can do, or am I stuck until I have to wear a
wig? I have lost at least 60% of my hair volume and the shedding is not ceasing. I’ve
tried DHT blockers, stimulating shampoos and Castor Oil, biotin and every other
supplement.

NDayal 8 months ago

Thank you Doctor for this informative article. I have a question - If the shedding is
because of antidepressant and the patient cannot discontinue the use of anti-

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8/12/2019 Will antidepressants exacerbate my hair loss? — Donovan Hair Clinic

depressant, what are the options? If the medication is continued would it lead to
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balding?

S A year ago

Thank you doctor, this post is very informative, that last sentence in particular. Two
quick follow up questions....

does the research show a similarly low risk for exacerbating AGA? (I believe I had
TE triggered by stopping birth control, which then facilitated early AGA. It started at
age 25 and I am now 28.) Or is the risk low only in regards to inciting TE sheds?
is the risk still low when weaning OFF antidepressants? I feel safer with the thought
of starting medication now, but given my horrendous experience with birth control
pills, I am fearful of what the withdrawal period could be like...

If you have any further opinions or research on the above I would greatly appreciate it!

Dr. Jeff Donovan A year ago

Anything that triggers shedding can worsen AGA. If one does not get shedding
with an anti-depressant it will likely not affect one's AGA and the AGA will
progress at whatever rate it was going to progress in the first place (AGA always
gets worse without treatment). If the anti-depressant causes a shed, it will then
likely worsen the AGA as well. Anything that causes a TE can worsen AGA. You
may wish to google a concept I have described many times and that is AFMPS
(accelerated follicular miniaturization from prolonged shedding). There is very
low risks of shedding when stopping anti-depressants if they did not cause much
shedding when starting or while on them.

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