Antidepressants and Hair Loss: What Solutions Are Available?

Which Antidepressants Cause Hair Loss?

To understand how antidepressants impact hair density, we should first look at the hair cycle.

Human hair follows a complex and well-regulated natural cycle. On average, the scalp contains between 100,000 and 150,000 hairs, with approximately 150 hairs renewed daily. This natural process is influenced by multiple factors, both genetic and hormonal, and evolves throughout life.

Each hair goes through three distinct phases during its existence:

• The anagen phase, or growth phase, extends over a period of 2 to 6 years. During this period, the hair actively develops.
• The catagen phase, or resting phase, lasts approximately 3 weeks. It is a transition period.
• The telogen phase, which leads to the natural shedding of hair over a period of 2 to 3 months, allowing for hair renewal.

Some antidepressants can disrupt this natural cycle, causing diffuse hair loss, particularly noticeable in women. The medicines most commonly associated with this side effect are fluoxetine, sertraline, and paroxetine (Etminan et al., 2018). Hair loss can occur within 2–3 months of starting treatment, although in some cases it can appear much earlier, sometimes within the first few weeks of treatment (Kıvrak et al., 2015).

A large comparative study showed that among common antidepressants, bupropion carries the highest risk of hair loss, whilst fluoxetine and paroxetine are associated with the lowest risks (Etminan et al., 2018).

Good to know: Under no circumstances should you stop taking antidepressant medication without consulting your GP or specialist, even if you’re experiencing hair loss.

What Other Medications Cause Hair Loss?

Medication-induced hair loss is not exclusive to antidepressants. Several categories of medicines can cause hair loss:

• Anticancer treatments are the most well-known cause of medication-induced hair loss. Hair follicle cells, characterised by their rapid multiplication similar to cancer cells, are particularly vulnerable to antineoplastic agents. Hair loss usually occurs between 7 and 10 days after the start of treatment, affecting hair in the anagen phase.
• Nonsteroidal anti-inflammatory drugs, such as ibuprofen and aspirin, can also cause hair loss with prolonged use. These medications can trigger telogen effluvium, characterised by an abnormal increase in hair shedding.
• Cholesterol medications and high blood pressure medications can interfere with the keratinisation process, weakening the cells responsible for hair production.

Good to know: Other categories of medicines known to impact hair health include anticoagulants, antiepileptics, lithium-based treatments, retinoids, and thyroid treatments.

What Are the Different Types of Medication-Induced Hair Loss?

Telogen Effluvium

Telogen effluvium is characterised by an abnormal increase in the number of hairs entering the renewal phase. Under the influence of medication, the lifespan of the hair is shortened, leading to diffuse hair loss across the entire scalp. This form of alopecia typically occurs 2 to 4 months after starting treatment. Although reversible when the medication is stopped, it can return if treatment is resumed. Clinical cases have shown that hair loss usually stops within weeks of discontinuing the offending medication, with normal regrowth following (O’Bryan & Albanese, 2004).

Anagen Effluvium

This form of alopecia is more severe and occurs more rapidly than telogen effluvium. The medication abruptly stops hair growth during its active phase. This type of hair loss is mainly observed during anticancer chemotherapy. As with telogen effluvium, the loss is typically reversible when treatment is stopped but may recur when treatment is resumed.

Androgenetic Alopecia

Certain medications, particularly corticosteroids and hormonal treatments containing androgenising substances, can trigger or worsen androgenetic alopecia in predisposed individuals. This form of alopecia manifests as a progressive miniaturisation of hair follicles sensitive to androgens, leading to thinning and localised hair loss.

What to Do in Case of Medication-Induced Hair Loss?

Although the majority of cases are reversible after stopping treatment, some patients must continue their medication because of its therapeutic importance.

In these situations, several strategies can be implemented to manage hair loss whilst maintaining essential treatment. First, consult a dermatologist or your GP to assess the severity of the hair loss and precisely identify the responsible medication. Depending on the case, they may consider therapeutic alternatives or adjust the dosages to minimise side effects, whilst maintaining the effectiveness of the treatment. For example, if fluoxetine causes hair loss, a switch to paroxetine could be considered, as the latter has a lower risk of alopecia according to comparative studies (Etminan et al., 2018). Complementary treatments may also be prescribed to support hair health.

Adopting an appropriate hair care routine is essential to maintain hair health. The use of specific shampoos enriched with vitamins and minerals, combined with scalp strengthening lotions, can help maintain hair vitality. It’s advisable to favour products without sulphates and parabens to minimise chemical aggression. The frequency of shampooing can be reduced to preserve the natural hydrolipidic film of the scalp.

A balanced nutritional approach plays a crucial role in hair health. An adequate intake of B vitamins, particularly biotin, as well as zinc and iron, helps promote hair growth. Amino acids, proteins and antioxidants are also essential to strengthen the hair structure and protect hair follicles. Omega-3, known for its anti-inflammatory action, can also be quite beneficial.

Important to remember: Patience is essential in the treatment of medication-induced hair loss, as regrowth can take several months after treatment adjustment.

What Are the Solutions for Irreversible Hair Loss?

In cases where hair loss proves irreversible, hair transplantation represents an effective and long-lasting solution. Several techniques are available:

• The FUE technique (Follicular Unit Extraction) has established itself as one of the most effective methods in the field of hair transplantation. This approach allows for precise extraction of follicular units one by one, offering particularly natural results whilst minimising scarring. The meticulous extraction and reimplantation process results in harmonious regrowth that blends in perfectly with the existing hair.

• The DHI method (Direct Hair Implantation) represents the most recent development in the field of transplantation techniques. This innovative approach is distinguished by its ability to perform direct implantation of follicles without the need for a prior incision. This unique feature significantly reduces tissue trauma and accelerates post-operative healing. The surgeon can thus precisely control the angle and depth of each implantation, ensuring a more natural final result. The time the grafts are exposed to open air is also reduced, which increases their survival rate and, consequently, the overall effectiveness of the procedure.

Turkey has established itself as a first-choice destination for these procedures, combining medical expertise and cutting-edge technologies. Specialised Turkish clinics, such as Dr. Cinik’s, have highly qualified and experienced medical staff trained in the latest hair transplantation techniques. The rigorous care protocols ensure consistent quality of service and optimal results. Another significant advantage is the excellent value for money offered, making these procedures more accessible than in many other countries, including the UK, Ireland and Canada.

Antidepressants and Hair Loss: What to Remember

• Antidepressants can have hair loss as a side effect. This hair loss usually occurs 2 to 3 months after starting treatment and is diffusely present throughout the scalp. However, the risk varies considerably between medications, with bupropion having the highest risk, whilst fluoxetine and paroxetine are associated with the lowest risks (Etminan et al., 2018).
• Discontinuing antidepressant treatment should never be decided independently, even in the case of significant hair loss. Your GP or psychiatrist can suggest therapeutic alternatives or adjust the dosage if necessary, whilst maintaining the effectiveness of the treatment.
• Medication-induced hair loss occurs in different forms, each with its own particularities: telogen effluvium, which is the most common form, causes diffuse and progressive hair loss; anagen effluvium, rarer but more brutal, directly interrupts hair growth; and androgenetic alopecia, which can be triggered or aggravated by certain medications in predisposed people.
• For cases where hair loss becomes irreversible, hair transplantation is a definitive and effective solution. Modern techniques such as FUE, Sapphire FUE and DHI offer natural and long-lasting results.

Sources

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. https://doi.org/10.1097/YIC.0000000000000191

Kıvrak, Y., Yağcı, İ., Üstündağ, M. F., & Özcan, H. (2015). Diffuse hair loss induced by sertraline use. Case Reports in Psychiatry, 2015, 703453. https://doi.org/10.1155/2015/703453

O’Bryan, E. C., & Albanese, R. P. (2004). A case report of fluoxetine- and venlafaxine-induced hair loss. Primary Care Companion to the Journal of Clinical Psychiatry, 6(4), 181. https://doi.org/10.4088/pcc.v06n0407