SSRI's and Hair Loss. How commonly do SSRI's Cause Hair Loss? Which Ones?

Which antidepressants are most consistently associated with hair loss?

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.

SSRIs include fluoxetine, fluvoxamine, sertraline, paroxetine, escitalopram and citalopram). They are approved for an array of different clinical indications including depression, anxiety, OCD, PTSD. The frist FDA approved selective serotonin reuptake inhibitor (SSRI) was fluoxetine. Fluoxetine was approved by the FDA in December of 1987 and was launched to the market in January 1988 under the trade name Prozac®

SSRI’s may cause hair loss. The exact risk is not clear but is estimated at 1 in 100 or less.

Prior studies of hair loss with SSRIs

Although SSRIs may be implicated in hair loss, it’s not clear that SSRIs really differ in their ability to cause hair loss.

in 2018, Etiman and colleagues set out to quantify the risk of hair loss with different antidepressants. They used a retrospective cohort study design using a large health claims database in the USA. The cohort was comprised of 1 025 140 new users of fluoxetine, fluvoxamine, sertraline, citalopram, escitalopram, paroxetine, duloxetine, venlafaxine, desvenlafaxine, and bupropion. In this data base, sertraline was the most commonly prescribed (N=190 227) and fluvoxamine (N=3010) was the least prescribed.

Compared with bupropion, all other types of antidepressants had a lower risk of hair loss, with fluoxetine and paroxetine having the lowest risk [hazard ratio (HR)=0.68, 95% confidence interval (CI): 0.63-0.74, HR=0.68, 95% CI: 0.62-0.74, respectively] and fluvoxamine having the highest risk (HR=0.93, 95% CI: 0.64-1.37).

Compared with fluoxetine, bupropion had the highest risk of hair loss (HR=1.46, 95% CI: 1.35-1.58, and paroxetine had the lowest risk (HR=0.99, 95% CI: 0.90-1.09).

Overall, the results of this 2018 population-based cohort study suggested an increase in the risk of hair loss with bupropion compared with selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors. However, there appeared to be similar risk among SSRIs. A trend existed for paroxetine to have the lowest risk.

Gautman. 1999.

In a 1999 review by Gautman, hair loss was most commonly reported with fluoxetine. Hair loss was found to be present after fluoxetine use in 725 cases and in 6, 7, and only 3 cases using fluvoxamine, paroxetine, and sertraline, respectively.

Pejcic and Paudel 2022

Authors examined reports of hair loss with SSRI types medications. There were a total of 71 patients reported in the medical literature with hair loss from SSRIs. Patients’ age ranged from 7 to 85 years and majority were female (80.3%). the SSRI most commonly reported in the literature to cause hair loss was fluoxetine, followed by sertraline, citalopram, escitalopram, fluvoxamine and paroxetine.

Alopecia most commonly affected scalp (n = 70; 98.6%), followed by eyelashes (n = 2; 2.8%), eyebrows (n = 2; 2.8%), axillary area (n = 2; 2.8%), legs (n = 1; 1.4%), chest (n = 1; 1.4%), pubic area (n = 1; 1.4%), and whole body (n = 1; 1.4%). Reported time to onset ranged from 3 days to 5 years.

Discontinuation of the suspected SSRI led to a recovery in a total of 51 of 81 episodes (63.0%) of hair loss

Comment and Discussion

This is an interesting paper. It does not set out to confirm if hair loss was indeed from the medication or to compare of perform statistical analysis. Rather than paper is a descriptive study of what exists in the literature. It’s actually difficult to draw alot of conclusions from this paper. However, the paper reminds us that there is a wide array of different presentations of hair loss with SSRI. The paper positions fluoxetine as being the most commonly reported SSRi in the medical literature to cause hair loss and paroxetine to be the least commonly reported.

If we rely on the 2018 data from Etiman we would be reassured that likely the risk of hair loss is similar among the SSRI medications. We don’t really know in these studies how common hair loss is from SSRI medications.

REFERENCE

Pejcic and Paudel. Alopecia associated with the use of selective serotonin reuptake inhibitors: Systematic review. Psychiatry Res. 2022 May 10;313:114620. 

Etiman M et al. Risk of hair loss with different antidepressants: a comparative retrospective cohort study. Int Clin Psychopharmacol 2018 Jan;33(1):44-48.

Gautam M. Alopecia due to psychotropic medications. Annals of Pharmacotherapy. 1999;33(5):631–637.