Antidepressants and Hair Loss

Hair loss is a personally devastating experience. Becoming bald can change your life in many ways. This can happen no matter your age. Even mature men and women dread losing their hair as they age. When hair loss does occur it can be personally devastating to a person’s social life and their perception of their selves. It is even more troubling in cases where a person has needed anti-depressant medications to treat clinical depression as many cases of hair loss linked to popular and often used antidepressants have been reported. This phenomenon of anti-depressant associated hair loss is largely unknown to the general public and it is rare to find physicians who are aware of it. This lack of recognition for this phenomenon does not make it any less real, nor does it make the personal pain of hair loss any easier to cope with if it is happening to you.

Hair loss with antidepressants have been linked to many different medications but mostly to those that have some affect on the dopaminergic neuro-chemical system (Mercke, 2000). These hair loss associations are not recognized as a common phenomenon and flying under the radars of so many patients and their doctors even a cursory review of medical literature readily reveals case upon case of hair loss linked to these medications (Kubota, 1993; Warnock, 1991; Baral, 1987). These medications play an important role in the care of so many people that blanket statements are both unfair and can be dangerous. The tragedy that can occur with abrupt discontinuation of antidepressants or with changing medications and dosages without trained clinical supervision are truly profound and should be avoided at all costs. Having said that and fully recognizing that anti-depressants save lives and let people live full healthy lives when necessary we must also be prepared to review our understanding of how important a healthy head of hair is to individuals who are at risk of losing this precious commodity. Telling a person who is prematurely losing their hair to ignore it or to accept it as a matter of course does not do them any favors. Any person losing their hair is not seeking to be ignored, and anyone facing a future of baldness deserves the respect, time and honest effort of their physician. As such it is important to be informed about hair loss, its many causes and the steps that can treat or reverse it.

If you are facing hair loss and are on an antidepressant, or in fact on any new medication started recently you can and should go to your physician and ask that the medicine be reviewed, or that a different medicine be tried. In some cases options may be limited but with many medications and with antidepressants specifically we have many options to attempt. A particular pill that causes hair loss in some will not necessarily do so in others. Just like some people are allergic to shellfish, and others to strawberries and still others to bee stings, some people will have side effects from specific antidepressants, and will be fine on another type even if it is of the same class of medications. In cases where a person is developing intolerable side effects from an entire class there are several different types of anti-depressants that work in a variety of different ways that can be tried.

Fluoxatine more commonly known as Prozac, and Sertraline sold under the label of Zoloft have been well recorded to have hair loss side effects (Ghanizadeh, 2008) but other drugs like duloxetine (Cymbalta), and even the earliest antidepressants, the tryciclic antidepressant family such as Elavil and Asendin have been linked to hair loss and hair thinning. Still each of these medications works differently and each family has it’s benefits and can be effective. If you have unwanted side effects from one family of drugs it does not automatically mean you will have them to another. If you are dealing with a crushing depression, a serious and life threatening illness, and on top of that are losing your hair don’t be idle about it, ask your doctor to review your medications and try something new. It may benefit you in more ways than one. If your doctor decides it is not safe to change your medications there are other cause of hair loss that can be checked that may also in turn help your depression. Medical illnesses like hypothyroidism commonly affect healthy hair growth and can cause depression, other medical causes like anemia can leave a person fatigued and feel sleepy and lethargic, affect their diets and look like depression and also lead to hair loss (Olszewska, 2010). Being depressed does not necessarily mean you do not have a second medical problem that can be contributing. In hair loss and balding it pays to be active and pro-active. Educate yourself, in many places on helpful websites like this one you can learn of medical causes of hair loss, possible treatments and therapies that can be reviewed with your physician. An educated patient can drive care, and sometimes in cases where the physician who has been trained for years to look for and treat life threatening diseases, some important but not fatal diseases may slip under the radar (Friedman, 1994). Asking for a specific review of your case is not rude or uncalled for. If you are right you do yourself a favor and any reasonable doctor should be happy to discuss your concerns with you.

Because of the fact that depression is a very real, devastating and potentially life threatening illness you must approach hair loss that may be occurs secondary to anti-depressants with care. First and foremost talk to your physician or psychiatrist. Do not stop your meds before consulting with your care provider (Warner, 2006). This is critical. These medications work by affecting the neuro-chemistry around your brain and suddenly stopping them can lead to catastrophic side effects, they can be safely stopped but many of them have to be slowly decreased over time. Sometimes days to weeks. Be patient but be active. Know that you can affect your life for the better. Work with a good doctor and proceed with optimistic caution. Your hair and your health will benefit from it.

Medical references:

1. Mercke Y, Sheng H, Khan T, Lippmann S.”Hair loss in psychopharmacology.” Ann Clin Psychiatry. 2000 Mar;12(1):35-42.

2. Kubota T, Ishikura T, Jibiki I. “Three cases of alopecia areata induced by zotepine”

Acta Neurol. 1993 Jun;15(3):200-3.

3. Warnock JK, Sieg K, Willsie D, Stevenson EK, Kestenbaum T. “Drug-related alopecia in patients treated with tricyclic antidepressants.” J Nerv Ment Dis. 1991 Jul;179(7):441-2.

4. Baral J, Deakins S. “Imipramine-induced alopecia areata-like lesions.” Int J Dermatol. 1987 Apr;26(3):198.

5. Ghanizadeh A. “Sertraline-associated hair loss.” J Drugs Dermatol. 2008 Jul;7(7):693-4.

6. Olszewska M, Warszawik O, Rakowska A, Słowińska M, Rudnicka L. “Methods of hair loss evaluation in patients with endocrine disorders.” Endokrynol Pol. 2010 Jul-Aug;61(4):406-11

7. Friedman M. “Iatrogenic alopecia.” J Fam Pract. 1994 Aug;39(2):114.